Cervical Epidural Steroid Might Be Waste of Time If Depressed?

Usually 60% of subjects will respond to steroid epidurals. However, in one study, if subjects were depressed, then on 1/5 cases responded. Why?

On Depression and Cervical Epidural Steroids
Nikolai Bogduk, MD, PhD, DSc
Pain Medicine, Volume 19, Issue 12, 1 December 2018, Pages 2333

Effect of Depression on Patient-Reported Outcomes Following Cervical Epidural Steroid Injection for Degenerative Spine Disease
Elliott J Kim, MD; Silky Chotai, MD; Byron J Schneider, MD; Ahilan Sivaganesan, MD; Matthew J McGirt, MD …
Pain Medicine, Volume 19, Issue 12, 1 December 2018, Pages 2371–2376,

Comment – One thing I remember was a description of Thoracic Outlet syndrome where one of the chief features was resistant depression. First thought I had about the case of steroid epidural non-responders was that they were obviously more mutli- dimensionally sick with facet syndromes, Thoracic outlet syndrome, myofascial and rib pain syndrome, and associated insomnia. Second thought was since finding 20-25% of fibromyalgia cases are bipolar, that maybe this dimension needs handling before given shots. Someone in a mixed state -jumpy, irritable, tense and not sleeping is not going to feel any better with just shots.  A common analogy to treating chronic pain is like peeling layers of an onioin to find there are many more layers underneath – treat with epidural and find the thoracic outlet, upper rib issues and myofascial pains. I give 2 thumbs down to present study because they did not bother to see what layers lay under the epidural non-responsive issues. Treated a back pain with a midazolam caudal just to find her ribs were impinging on one side iliac crest and needed treatment as well – could have had a SI joint or piriformis or thoracolumbar issues as well

 

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