Epistemological Injections: A Therapeutic Trial

Therapeutic trials like chess gambits offer the possibility of resolving a complex situation quickly.

An epistemological injection is a term we use at Schlesinger Pain Centers for a therapeutic trial of lumbar epidural steroid injection (LESI). It is a clinical gambit, which actually occurs quite frequently. Many patients present with unusual or discordant symptoms and as we have said in the page on epistemology, making an initial diagnosis may be difficult or uncertain.  In other cases patients present with purely axial back pain suggestive of posterior column pathology, such as facet arthropathy, yet we know from statistical studies that the most common cause of axial back pain is actually nerve root irritation.  Finally, in cases such as this, if the patient responds to therapy, establishing an exact diagnosis becomes less important and if the patient fails to respond we can cross one more thing off the list.  These facts combine with the relative safety and simplicity of these injections make a therapeutic trial of steroid injection an attractive option.

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