Increased dose of betamethasone for transforaminal epidural steroid injections is not associated with superior pain outcomes at 4 weeks

Background: fluoroscopically guided transforaminal epidural steroid injections (fg-tfesis) have been shown to provide both immediate and long-term improvement in patients’ selfreported pain. administration of the lowest possible dose of epidural betamethasone is desired to minimize side effects while maintaining efficacy. we hypothesize that a 3 mg or a 6 mg dose of betamethasone will demonstrate equivalent analgesic properties. objectives: to compare the analgesic efficacy of 3 mg and a 6 mg dose of betamethasone for use in fg-tfesi. study design: retrospective evaluation. setting: academic outpatient pain center. methods: one hundred fifty-eight patients underwent fg-tfesi for lumbar back pain between 2012 and 2013. depending on the date of service,a dose of 3 mg or a dose of 6 mg betamethasone was used in the single level unilateral tfesi. opioid consumption and nrs-11- 11 pain score were analyzed pre-procedurally and at a clinic visit 4 weeks post-procedurally. results: changes in numerical rating scale (nrs-11-11) pain score (-1.21 + 2.61 vs. -0.81 + 2.40 respectively,p = 0.17) and changes in opioid consumption as measured in oral morphine equivalents (-2.94 + 16.4 mg vs. -2.93 + 14.8 mg,p = 0.17) were statistically equivalent between both groups. intergroup sub-analysis of those with > 50% reduction in baseline nrs-11-11 pain score was not different (15.2% vs. 34%,p = 0.56),and the proportion with a vrs pain score < 3 were similar (24.5% vs. 23.8%,p = 0.92). limitations: potential selection bias inherent with study design. conclusions: reduction in nrs-11-11 pain scores and narcotic usage at 4 weeks after fg-tfesi were statistically equivalent between patients who received 3 mg or 6 mg of betamethasone,suggesting that a lower steroid dose has similar analgesic efficacy. irb number: cedars-sinai medical center institutional review board pro00031594. © 2015,american society of interventional pain physicians. all rights reserved.