Management of Neuropathic Pain with Methylprednisolone at the Site of Nerve Injury

1. Pain Medicine
2. H. Evren Eker MD^*, 
3. Oya Yalcin Cok MD, 
4. Anis Aribogan MD, PhD, 
5. Gulnaz Arslan MD, PhD
6. 1. Article first published online: 7 FEB 2012
      DOI: 10.1111/j.1526-4637.2011.01323.x
      Abstract
      Objective.  Peripheral nerve blocks with methylprednisolone may provide effective pain therapy by decreasing ectopic neuronal discharge and the release of local inflammatory mediators at the site of nerve injury. In this study, we aimed to compare the efficacy of lidocaine alone with a combination of depo-methylprednisolone plus lidocaine in the management of neuropathic pain due to peripheral nerve damage.

Design.  Randomized, double-blind comparator trial

Setting.  Group control (N = 44) received 0.5% lidocaine and group methylprednisolone (N = 44) received 80 mg depo-methylprednisolone + 0.5% lidocaine proximal to the site of nerve injury with a total amount of 10–20 mL solution according to the type of peripheral nerve block with nerve stimulator.

Outcome Measures.  Demographic data, preblock numerical rating scales (NRSs), the Leeds assessment of neuropathic symptoms and signs (LANSS₀) score, accompanying symptoms, and analgesic requirements were recorded. Postblock NRS scores were noted following peripheral nerve block and after 3 months. LANSS₁, accompanying symptoms, and analgesic requirements were also reevaluated 3 months after the injection.

Results.  Demographic data, preblock NRS (8 ± 1.5 and 8.1 ± 1.2, respectively), postblock NRS (2.1 ± 1.2 and 2.4 ± 1.4, respectively), LANSS₀ (18.4 ± 2.2 and 18.2 ± 2.1, respectively), and accompanying symptoms were comparable between groups. Scores for the methylprednisolone group were significantly improved at 3-month postblock for NRS (2 ± 1.4 vs 5.2 ± 1.7) and LANSS₁ scores (4.14 ± 2.7 vs 14.1 ± 2.8), accompanying symptoms, and analgesic requirements (P < 0.0001).

Conclusions.  Our results suggest that peripheral nerve block with 80 mg depo-methylprednisolone plus 0.5% lidocaine provides effective management in the treatment of neuropathic pain due to peripheral nerve damage.