Serene landscape with a glowing spine symbolizing pain relief.

Back Pain Breakthrough: Could a Combined Epidural Be the Answer?

Samir D’Costa in Health & Wellness August 2025 • 4 min read.

"A new study explores how a combination of morphine and bupivacaine could offer lasting relief for chronic lower back and leg pain, even after treatment stops."

Chronic lower back and leg pain, often stemming from issues in the spine, significantly diminishes the quality of life for many adults. While not all back pain leads to radiating leg pain, when it does, the symptoms can vary widely, presenting a challenge for both patients and healthcare providers. This type of neuropathic pain has been a 'dark zone' in medicine, with effective treatments remaining elusive.

Neuropathic pain arises from damage or dysfunction of the somatosensory system and affects a significant portion of the population. Traditional therapies, including medications and surgery, often fall short, and interventional procedures like spinal cord stimulation are not universally applicable. Although some studies have questioned the effectiveness of opioids for neuropathic pain, ongoing research continues to explore their potential role.

Researchers are now investigating new approaches, including combinations of medications delivered directly to the spinal cord. One promising avenue involves combining opioids with local anesthetics like bupivacaine, aiming to maximize pain relief while minimizing side effects. A recent study explored whether epidural administration of morphine and bupivacaine could provide lasting pain relief for individuals with chronic neuropathic pain associated with lumbosacral radiculopathy.

Unlocking Pain Relief: How Does Combined Epidural Therapy Work?

Serene landscape with a glowing spine symbolizing pain relief.

The study, published in the Journal of Pain Research, focused on the therapeutic effectiveness of epidural morphine and bupivacaine in patients experiencing chronic lumbosacral radicular neuropathic pain. Researchers enrolled twenty-two patients with this condition and administered an epidural injection of morphine chlorhydrate and bupivacaine up to three times a day for four weeks. An indwelling catheter was placed into the epidural space to facilitate the delivery of medication.

Pain intensity was assessed using a 0-10 numeric rating scale (NRS) and the total pain rating index rank (PRIr-T). These scores, along with their coefficients, were evaluated before treatment and one month after the catheter was removed. The goal was to determine if the combined therapy could provide sustained pain relief even after the medication was discontinued.

Participants: 22 patients with chronic lumbosacral pain showing neuropathic characteristics.
Treatment: Epidural injections of morphine chlorhydrate and bupivacaine were administered up to three times daily for four weeks.
Assessment: Pain intensity was measured using the NRS and PRIr-T scales, both before and after the treatment period.

The results showed a significant reduction in both NRS and PRIr-T scores at the one-month follow-up, indicating a notable decrease in pain intensity. The parallel evolution of the two scores further confirmed that the pain relief lasted even after the treatment ceased. Interestingly, none of the four pain rating coefficients were significantly modified in either responders or non-responders. Successful clinical outcomes, defined as a pain reduction of >30% in NRS, were observed and maintained in half of the patients at follow-up. The study suggests that combined epidural morphine and bupivacaine can be an effective approach for treating neuropathic pain.

The Future of Pain Management: What's Next?

This study provides valuable insights into the potential of combined epidural morphine and bupivacaine for managing chronic neuropathic pain. By demonstrating sustained pain relief even after treatment cessation, the research opens doors for new therapeutic strategies. While further studies are needed to evaluate the long-term safety and efficacy of this approach, these findings offer hope for individuals seeking effective solutions for debilitating lower back and leg pain.

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Everything You Need To Know

What is the specific combination of drugs used in the combined epidural therapy for back pain?

The combined epidural therapy involves the administration of morphine and bupivacaine. These medications are delivered directly into the epidural space near the spinal cord to provide pain relief. The study specifically used morphine chlorhydrate with bupivacaine.

How does the combined epidural treatment with morphine and bupivacaine work to alleviate chronic lower back and leg pain?

The treatment uses a combined approach where morphine, an opioid, is combined with bupivacaine, a local anesthetic. This combination is administered epidurally, directly to the spinal cord. The goal is to maximize pain relief by leveraging the different mechanisms of action of each drug. Morphine acts on opioid receptors to reduce pain signals, while bupivacaine blocks nerve signals, thus reducing the pain perception. This approach aims to offer sustained pain relief even after the treatment has ended, as demonstrated by the study.

What were the key findings of the study regarding the effectiveness of the combined epidural therapy?

The study showed a significant reduction in pain intensity, as measured by the NRS (0-10 numeric rating scale) and PRIr-T (total pain rating index rank) scores, one month after the combined epidural treatment with morphine and bupivacaine was completed. This indicates that the pain relief lasted even after the medication was discontinued. Notably, more than 30% pain reduction was observed and maintained in half of the patients at follow-up, indicating the potential for lasting benefits. No significant changes were observed in pain rating coefficients.

What is 'chronic lumbosacral radicular neuropathic pain,' and why is it challenging to treat?

Chronic lumbosacral radicular neuropathic pain refers to persistent pain in the lower back and legs, often stemming from issues in the spine that affects nerves. This type of pain is categorized as neuropathic, which arises from damage or dysfunction of the somatosensory system. It is notoriously challenging to treat because traditional therapies, like medications and surgery, often prove inadequate. The nature of neuropathic pain is complex, and it has been a 'dark zone' in medicine, where effective treatments are elusive, making this combined epidural therapy a promising avenue.

What are the implications of using combined epidural therapy with morphine and bupivacaine for chronic back pain, and what are the next steps in research?

The implications of this therapy are significant, particularly for individuals with chronic lower back and leg pain, as the study suggests it can provide sustained pain relief. The study opens doors for new therapeutic strategies by demonstrating that the relief can last even after the treatment has ended. The next steps involve further studies to evaluate the long-term safety and efficacy of this approach. This will help to refine the treatment protocols, identify optimal dosages, and determine which patients are most likely to benefit from this combined therapy. Further research is crucial to validate these findings and translate them into clinical practice.