Epidurolysis in the Treatment of Chronic Back Pain – Retrospective Analysis

Uvod. Bol u donjem dijelu leđa je najčešći razlog dolaska bolesnika u ambulantu za liječenje boli i predstavlja veliki javnozdravstveni problem. Epiduroliza predstavlja minimalno invazivan postupak, kojim se omogućuje djelomično ili potpuno smanjenje pritiska na korijene kralježničnih živaca, s ciljem smanjenja intenziteta boli. Cilj. Cilj ovog istraživanja bio je utvrditi u kojoj se mjeri nakon učinjenog postupka epidurolize smanjuje bol u donjem dijelu leđa s osvrtom na nociceptivnu i neuropatsku bol. Metode. Retrospektivno istraživanje obuhvatilo je 50 bolesnika koji su liječeni postupkom epidurolize u Ambulanti za liječenje boli Kliničkog bolničkog centra Sestre milosrdnice (Zagreb, Hrvatska). Istraživanjem su analizirani podaci iz bolničkog informacijskog sustava. Obuhvaćeni su bolesnici za koje postoje dostatni podaci u informacijskom sustavu, a koji su liječeni u posljednjih 5 godina. Prikupljanje podataka provodio je istraživač osobno. U analizu su uzeti samo bolesnici za koje su postojali podaci za sva istraživanjem predviđena mjerenja (NRS, Pain detect upitnik i potrošnja analgetika) za sve tri vremenske točke mjerenja. Analizirane su dvije komponente boli, nociceptivna i neuropatska komponenta boli putem standardiziranih upitnika. Rezultati. Istraživanje je uključilo 50 bolesnika, od kojih je bilo 14 muškaraca i 36 žena u dobi od 28 do 85 godina. Podaci o doživljaju nociceptivne boli dobiveni su temeljem procjena putem numeričke skale za procjenu boli (NRS) od 0 do 10 i standardiziranog i validiranog upitnika Pain detect za procjenu neuropatske boli. Po pitanju intenziteta boli, rezultati su pokazali da je došlo do značajnog smanjenja doživljenog intenziteta boli nakon postupka epidurolize (p<0,01). Statistički značajna razlika uočena je 3 tjedna nakon postupka, pri čemu je srednja vrijednost intenziteta boli bila značajno manja, a 6 mjeseci nakon postupka je viša od vrijednosti u drugom mjerenju, no i dalje značajno niža od vrijednosti prije postupka (p<0,05). Zaključak. Provedenim istraživanjem potvrđena je hipoteza koja je glasila da se nakon učinjene epidurolize bol u donjem dijelu kralježnice u značajnoj mjeri smanjuje po tipu nociceptivne i neuropatske boli.Background. Low back pain is the most common reason patients come to the clinic for pain management and is a major public health problem. Epidurolysis is a minimally invasive procedure that allows partial or complete pressure relief of the spinal nerve roots, with the goal of reducing pain intensity. Aim. The aim of this research was to determine to what extent pain in the lower back is reduced after the epidurolysis procedure, with reference to nociceptive and neuropathic pain. Methods. The retrospective study included 50 patients treated with the epidurolysis procedure at the Pain Clinic of University Hospital Center Sestre milosrdnica (Zagreb, Croatia) for whom sufficient data were available in the information system. Data from the hospital IT system were analyzed for the study. Patients for whom sufficient data were available in the information system and who were treated in the last 5 years were included. Only patients were included in the analysis for whom there were data for all the studies provided for measurements (NRS, Pain detect questionnaire and consumption of analgesics) for all three measurement time points. Two components of pain, the nociceptive and neuropathic components of pain, were analyzed using the Pain Recognition Questionnaire and The Numeric Rating Scale. Results. There were 50 patients in the study, including 14 men and 36 women, whose age ranged from 28 to 85 years. Data on the experience of nociceptive pain were collected based on ratings using a numerical pain rating scale (NRS) from 0 to 10 and the international standardized and validated questionnaire Pain detect for the assessment of neuropathic pain. Regarding pain intensity, the results showed that perceived pain intensity significantly decreased after the epidurolysis procedure (p < 0.01). The mean value of pain intensity 3 weeks after the procedure is significantly lower, and 6 months after the procedure it is higher than the value at the second measurement, but still significantly lower than the value before the procedure (p < 0.05). Conclusion. The studies performed confirmed the hypothesis that after epidurolysis there is a significant decrease in low back pain, both nociceptive and neuropathic pain