Publication:

Comparison of the effectiveness between epidural methylprednisolone injection and intranasal calcitonin in reduction of back pain due to osteoporosis in postmenopausal patients: a randomized controlled trial

Background Back pain is a common symptom in osteoporotic patients due to spinal compression fracture. Conservative management like nonsteroidal anti-inflammatory drugs and spinal orthoses has not been able to produce early pain relief. Intranasal calcitonin spray is considered effective because of its analgesic effect and increase in bone density. Role of epidural steroid injection for the treatment of osteoporotic back pain has not been studied. This study was conducted to find out the efficacy of epidural methylprednisolone injection in management of osteoporotic back pain in postmenopausal patients.

Methods Hundred patients with osteoporotic back pain in postmenopausal subjects were allocated into two groups: epidural and calcitonin. Epidural group received a single dose of interlaminar epidural steroid injection with methylprednisolone 80 mg. Calcitonin group received one puff of 200 IU given through one nostril followed to the other nostril the next day. Visual analogue scale for pain was the outcome measurement used. Pain relief at rest within 7 days was taken as early pain relief and within 21days as late pain relief. Pain relief after 21st day was considered no response. Test of significance was done by Kaplan Meier, Chi square and Fisher exact tests.

Results Out of 50 patients, 38 patients in the epidural group got pain relief within 7 days and the finding was statistically significant.

Conclusions Epidural methylprednisolone gives faster pain relief as early as the first post-injection day with a median value of 2 days against 15 days in case of intranasal calcitonin spray.