الفهرس 
Introduction & Aim of WorkOnly 14 pages are availabe for public view
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Abstract
Low back pain has been with humans since at least the Bronze Age. The oldest known surgical treatise dating to about 1500 BCE – describes a diagnostic test and treatment for a vertebral sprain.
Lumbar epidural baclofen bolus injection for intractable spasticity which cause low back pain is thought to act by crossing the dura to act directly in the spinal canal just like morphine, as high morphine concentration had been found in IT space after epidural morphine injection, in spite of lacking an assay to measure IT baclofen concentration. baclofen transport across the blood brain barrier (BBB) was through a carrier-mediated transport system, rather than passive diffusion. Moreover,the transport of baclofen across BBB was stereoselective.
Addition of Steroid to the hyperosmolar sodium chloride solution can reach the appropriate site and provide anti-inflammatory effect, and neural blockade. Experiments on hypertonic saline and nerve conduction showed that osmolar depletion of water content within the peripheral
axons resulted in decreased nerve conduction and attenuation of transmitter release from neuromuscular junctions exposed to hypertonic solutions.
This study was designed to compare between the use of multiple doses of epidural baclofen with single dose steroids in addition to epidural hypertonic saline10%̦ the use of single dose epidural baclofen plus steroid added to epidural hypertonic saline10% and the use of steroid alone as additive to epidural hypertonic and multiple doses in patients with low back pain.
Our study showed that baclofen single dose was associated with rapid pain releaving effect and more side effects. but baclofen multiple doses was associated with delayed but effective pain relief with less side effects.