Assessment of the Effectiveness of Transforaminal Epidural Injection withTrigger Point Injection in the Treatment of Low Back Pain: AComparative Study

Background: Chronic low back pain (CLBP) is a prevalent clinical condition with multifactorial etiology, ofteninvolving both radiculopathy and myofascial trigger points. While Transforaminal Epidural Steroid Injection(TFESI) is an established intervention for radicular pain, it may be insufficient when myofascial components areconcurrently present. This study evaluates whether combining TFESI with Trigger Point Injection (TPI) offerssuperior pain relief and functional outcomes compared to TFESI alone.Objectives: To assess and compare the effectiveness of TFESI alone versus TFESI combined with TPI in reducingpain intensity, improving functional status, prolonging analgesic duration, and reducing analgesic requirement inpatients with chronic low back pain.Methods: This was a prospective, comparative study conducted from January 2018 to December 2018 atDepartment of Anesthesia, Government Medical College, Bettiah, Bihar, India. A total of 120 patients withchronic low back pain were randomly divided into two groups: Group A received TFESI alone, while Group Breceived TFESI combined with TPI. Pain severity was measured using the Visual Analogue Scale (VAS), andfunctional impairment was assessed using the Oswestry Disability Index (ODI). Assessments were done atbaseline, 1 week, 1 month, and 3 months post-procedure. Duration of analgesia, rescue analgesic requirement,adverse effects, and patient satisfaction were also recorded.Results: Both groups showed significant improvement in VAS and ODI scores post-intervention. However,Group B (TFESI + TPI) demonstrated significantly better pain relief and functional outcomes at all follow-upintervals (p < 0.001). The duration of analgesia was significantly longer in Group B (8.7 ± 2.2 weeks) than inGroup A (4.1 ± 1.4 weeks), and fewer patients in Group B required rescue analgesics. Patient satisfaction washigher in the combination group, and no major complications were reported.Conclusion: The combination of TFESI with TPI provides enhanced and prolonged analgesia, superior functionalimprovement, and greater patient satisfaction compared to TFESI alone in managing chronic low back pain. Thiscombined approach is safe, effective, and should be considered in routine clinical practice for patients with bothradicular and myofascial components of pain.