173: Effect of Transforaminal Epidural Steroid Injections on Gabapentinoid Use in Lumbar Radicular Pain

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Pharmacological treatments, Non-pharmacological treatments, Treatment/management

Background and Aims: Lumbar radicular pain is a common neuropathic condition most frequently caused by lumbar disc herniation and spinal stenosis. Gabapentinoids are widely used for its management; however, long-term use is limited by modest efficacy, adverse effects, and concerns regarding misuse. Transforaminal epidural steroid injections(TFESI) provide targeted anti-inflammatory treatment and are supported by strong evidence for radicular pain relief. While previous studies have compared the efficacy of gabapentinoids and epidural injections, data on the impact of TFESI on gabapentinoid use are limited. This study aimed to evaluate changes in gabapentinoid use and pain intensity following TFESI in patients with lumbar radicular pain.

Methods: This retrospective study included adults aged 18-65 years with unilateral, single-level lumbar radicular pain secondary to disc herniation who underwent single-level TFESI between June 2022 and May 2024. Patients with spinal stenosis, multilevel injections, or other neuropathic pain conditions were excluded. Demographic and clinical data, symptom duration, number of injections, prior lumbar surgery, and gabapentinoid use before and after TFESI were recorded. Pain intensity was assessed using the Numerical Rating Scale(NRS) at baseline and three weeks post-procedure. Magnetic resonance imaging was reviewed to grade nerve root compression.

Results: A total of 321 patients were included. Mean NRS scores decreased from 8.05±1.39 at baseline to 3.58±2.72 at three weeks following TFESI. Among patients using gabapentinoids prior to the procedure (n=102), 51.0% discontinued and 12.7% reduced their dose, yielding an overall medication reduction rate of 63.7%. Of patients not receiving gabapentinoids before TFESI (n=219), 90.4% remained medication-free. Longer symptom duration was associated with less favorable medication outcomes. Repeated injections were more frequently observed among patients who reduced or discontinued gabapentinoid use. High-grade nerve root compression was more frequently observed in patients with gabapentinoid exposure compared with medication-naive patients.

Conclusions: TFESI were associated with clinically meaningful reductions in pain intensity and gabapentinoid use in patients with lumbar radicular pain. Pain scores markedly decreased by the third week following TFESI, accompanied by a substantial medication-sparing effect, with nearly two-thirds of prior gabapentinoid users reducing or discontinuing therapy. Patients who were medication-naive largely remained free of gabapentinoid treatment after intervention. Longer symptom duration and high-grade nerve root compression were associated with less favorable medication outcomes, whereas repeated injections appeared to enhance treatment response. These findings support TFESI as an effective component of pain management aimed at reducing both pain and pharmacologic burden.

References: 1. Peene L, Cohen SP, Kallewaard JW, et al. 1. Lumbosacral radicular pain. Pain Pract. 2024;24(3):525-552.
2. Dworkin RH, O'Connor AB, Backonja M, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain. 2007;132(3):237-251.
3. Oliveira CB, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev. 2020;4(4):CD013577.
4. Cohen SP, Hanling S, Bicket MC, et al. Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study. BMJ. 2015 Apr 16;350:h1748.

Presenting Author: Savas Sencan, Assoc. Prof.
Submitting Author: Nurbanu Hindioglu Dogan

Senior Author: Osman Hakan Gunduz, Prof.

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Nurbanu Hindioglu Dogan: MD - Marmara University, School of Medicine, Department of Physical Medicine and Rehabilitation, Division of Pain Medicine
• Savas Sencan: Assoc. Prof. - Marmara University, School of Medicine, Department of Physical Medicine and Rehabilitation, Division of Pain Medicine
• Mikdat Can Karabiyik: MD - Marmara University, School of Medicine, Department of Physical Medicine and Rehabilitation
• Serdar Kokar: Assoc. Prof. - Marmara University, School of Medicine, Department of Physical Medicine and Rehabilitation, Division of Pain Medicine
• Osman Hakan Gunduz: Prof. - Marmara University, School of Medicine, Department of Physical Medicine and Rehabilitation, Division of Pain Medicine