A Comparative Study on Low Back Pain with Radiculopathy treated with Conventional NSAIDs versus Combination of Caudal Epidural Steroid Injections and NSAIDs

Background:Low back pain (LBP) with radiculopathy is a common, debilitating condition that adversely affects patients' quality of life and imposes a significant economic burden on healthcare systems. While NSAIDs are widely used for pain relief, their limited effectiveness in managing radicular pain highlights the need for adjunctive therapies such as caudal epidural steroid injections (CESIs). This study compares the effectiveness of NSAIDs alone versus a combination of NSAIDs and CESIs for managing LBP with radiculopathy, focusing on degenerative joint disease (DJD), acute disc prolapse (ADP), and paraspinal muscle spasm (PSMS). Method:A randomized controlled trial was conducted, including 100 adult patients diagnosed with LBP and radiculopathy confirmed by MRI. Participants were randomized into two groups: NSAIDs alone and NSAIDs combined with CESIs. Pain relief was assessed at one and three weeks using the Numeric Pain Rating Scale (NRS). Statistical analyses were conducted with chi-square tests, using p ≤ 0.05 as the threshold for significance. Results:Patients with DJD experienced significantly greater pain relief with the combination therapy. By the third week, 94.1% of DJD patients receiving CESIs with NSAIDs reported significant or complete pain relief compared to 58.3% in the NSAIDs-alone group (p < 0.05). No significant differences were observed between the groups for ADP or PSMS (p > 0.05). Conclusions:CESIs combined with NSAIDs are superior for managing DJD-related LBP, while NSAIDs alone may suffice for ADP and PSMS. Personalized treatment strategies are recommended based on underlying pathology. Keywords:Low back pain, radiculopathy, degenerative joint disease, acute disc prolapse, paraspinal muscle spasm, NSAIDs, caudal epidural steroid injections.