Epidural Blood Patch does not Contribute to the Development of Chronic Low Back Pain in Patients who Undergo Lumbar Punctures: A Pilot Study

Jamal Hasoon; Ivan Urits; Mark Burroughs; Viet Cai; Vwaire Orhurhu; Musa Aner; Cyrus Yazdi; Thomas Simopoulos; Omar Viswanath; Alan D Kaye; Philip E Hess; Jatinder Gill

Epidural Blood Patch does not Contribute to the Development of Chronic Low Back Pain in Patients who Undergo Lumbar Punctures: A Pilot Study

Psychopharmacol Bull. 2020 Oct 15;50(4 Suppl 1):17-24.

Authors

Affiliation

¹ Hasoon, MD, Cai, MD, Aner, MD, Yazdi, MD, Simopoulos, MD, Hess, MD, Gill, MD, Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Burroughs, MD, Methodist Dallas Medical Center, Department of Surgery, Dallas, TX. Orhurhu, MD, MPH, Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA.

PMID: 33633414
PMCID: PMC7901133

Abstract

Purpose of review: Post dural puncture headache (PDPH) is a known and relatively common complication which may occur in the setting of patients undergoing lumbar punctures (LP) for diagnostic or therapeutic purposes, and is commonly treated with an epidural blood patch (EBP). There have been few publications regarding the long-term safety of EBP for the treatment of PDPH.

Recent findings: The aim of this pilot study was to examine any association of chronic low back pain (LBP) in patients who experienced a PDPH following a LP, and were treated with an EBP. A total of 49 patients were contacted and completed a survey questionnaire via telephone. There was no increased risk of chronic LBP in the dural puncture group receiving EBP (percentage difference 1% [95% CI -25% - 26%], RR: 0.98 [95% CI 0.49 - 1.99]) compared to the dural puncture group not receiving EBP. There were no significant differences in the severity and descriptive qualities of pain between the EBP and non-EBP groups. Both groups had higher prevalence of back pain compared to baseline.

Summary: Our findings suggest that dural puncture patients undergoing EBP do not experience low back pain with increased frequency compared to dural puncture patients not undergoing EBP. Higher prevalence of LBP compared to baseline and compared to general population was seen in both groups. However, this pilot study is limited by a small sample size and no definitive conclusion can be drawn from this observation. The findings of this study should spur further prospective research into identifying potential associations between LP, EBP and chronic low back pain.

Keywords: chronic low back pain; epidural blood patch; lumbar puncture; post dural puncture headache.

Publication types

Review

MeSH terms

Blood Patch, Epidural
Humans
Low Back Pain* / etiology
Pilot Projects
Post-Dural Puncture Headache* / epidemiology
Post-Dural Puncture Headache* / etiology
Post-Dural Puncture Headache* / therapy
Spinal Puncture / adverse effects