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23rd Annual Pain Medicine Meeting 2024
November 21-23, 2024 | Caesars Palace, Las Vegas, Nevada
5933
PARASPINAL KETOROLAC INJECTION FOR CHRONIC, REFRACTORY LOWER BACK PAIN: A CASE REPORT.
Poster Presenter
Part of Topic
Scientific Abstracts > Chronic Pain
Title: Paraspinal Ketorolac Injection for Chronic, Refractory Lower Back Pain: A Case Report
Richard Catabona, DO; Luigi P. Gonzales, BS; Armand Ardestani, DO; Keshin Purohit, MD; Edwin Barawid DO
INTRO
•Over 80% of adults will experience low back pain in their lives.1
•Low back pain is associated with both high healthcare costs and indirect costs due to lower productivity and missed work.
•Review of literature suggested that non-steroidal anti-inflammatory drugs (NSAIDs) are effective for short-term symptomatic relief in patients with acute and chronic low back pain without sciatica.2,3
•However, limited research has been performed on the effectiveness of injection of NSAID for treatment of acute low back pain.
CASE DESCRIPTION
Chief Complaint:
•73-year-old male with acute on chronic low back pain.
History and Physical Exam:
•Patient presented with 8/10 intractable low back pain without radicular symptoms that worsened with ambulation.
•Inspection revealed hypolordosis of the lumbar spine.
•There were palpable trigger points, tight paraspinal musculature with tenderness to palpation at the L4-L5 levels bilaterally with significantly reduced range of motion.
Imaging:
•Lumbosacral radiograph was significant for degenerative changes.
Prior Treatments:
•Physical therapy was not completed due to severity of pain.
•Tylenol, Robaxin, and Gabapentin no longer provided adequate relief.
Intervention:
•Ketorolac 30mg (1cc) + Lidocaine 1% (4cc) trigger point injection (TPI) with peppering technique was administered to the L4-L5 lumbar paraspinals bilaterally.
RESULTS
•1-week post-injection, the patient reports 80% improvement of his pain. He also endorsed substantial functional improvement in mobility, reporting ability to ambulate around his house without an assistive device.
DISCUSSION
•While systemic NSAID administration has been shown to provide short-term pain relief in patients with low back pain, localized administration of NSAIDs provide a more effective response.
•Multiple studies have demonstrated the effectiveness of TPI, a local, targeted treatment approach, in relieving back pain.4,5
•However, few studies have evaluated the efficacy of direct NSAID administration into the lumbar paraspinals in combination with TPI peppering technique for treatment of acute myofascial pain in the lumbar spine.
•While the therapeutic effect of Ketorolac has been shown to last for up to 33 hours, our case report revealed improvements in symptoms and function up to 1 week post injection.
•Further studies are needed to gain a better understanding of the efficacy of the combined treatment of NSAID injection with TPI in treating lower back pain.
REFERENCES
1.Abdullah Osman Kocak, Ali Ahiskalioglu, Emre Sengun, Sultan Tuna Akgol Gur, Ilker Akbas. Comparison of intravenous NSAIDs and trigger point injection for low back pain in ED: A prospective randomized study. The American Journal of Emergency Medicine.2019; 37(10):1927-1931.https://doi.org/10.1016/j.ajem.2019.01.015.
2.Enthoven WT, Roelofs PD, Deyo RA, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database Syst Rev. 2016 Feb 10;2(2):CD012087. doi: 10.1002/14651858.CD012087. PMID: 26863524; PMCID: PMC7104791.
3.Lehn C, Chipman C, Augustine S, Lyon C, DeSanto K. Trigger Point Injection for Low Back Pain. Am Fam Physician. 2023 Jul;108(1):85-86. PMID: 37440745.
4.Martin BI, Tosteson ANA, Lurie JD, et al. Variation in the Care of Surgical Conditions: Spinal Stenosis: A Dartmouth Atlas of Health Care Series [Internet]. Lebanon (NH): The Dartmouth Institute for Health Policy and Clinical Practice; 2014 Oct 28. Back pain in the United States. Available from: https://www.ncbi.nlm.nih.gov/books/NBK586768/
Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2008 Jan 23;2008(1):CD000396. doi: 10.1002/14651858.CD000396.pub3. PMID: 18253976; PMCID: PMC10220428