Kanai A, et al. - Experts assessed the safety and efficacy of intrathecal injection as an alternative to epidural injection for analgesia in this study involving 70 consecutive outpatients with chronic low back and lower extremity pain. Study participants received lumbar intrathecal injection of low-dose isobaric bupivacaine using a 25-gauge pencil-point needle. To determine the optimal dose, the investigators administered 0.5 mg, 1.0 mg, and 1.5 mg of bupivacaine to participants at 1-week intervals. In addition to providing anesthesia below L1, the optimal dose of bupivacaine (1.0 mg in 60% of patients) was found to alleviate pain and disability. They researchers also noted negligible motor block and an improvement in balance impairment relative to baseline. Overall, findings revealed intrathecal injection of low-dose bupivacaine to be a safe and effective treatment for chronic low back and lower extremity pain.