Factors Associated With Pain Reduction After Transforaminal Epidural Steroid Injection for Lumbosacral Radicular Pain

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• 作者：Zachary McCormick ; MD^a ; ^{zmccormi@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Daniel Cushman ; MD^a ; Ellen Casey ; MD^a ; Cynthia Garvan ; PhD^b ; David J. Kennedy ; MD^c ; Christopher Plastaras ; MD^d
• 关键词：Back pain ; Injections ; epidural ; Lumbosacral region ; Radiculopathy ; Rehabilitation
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：95
• 期：12
• 页码：2350-2356
• 全文大小：198 K

文摘

To identify demographic and clinical factors associated with pain improvement after a lumbosacral transforaminal epidural steroid injection (TFESI) for the treatment of radicular pain.

Design

Retrospective cohort study.

Setting

Outpatient center.

Participants

Adults (N=188) who underwent a fluoroscopically guided TFESI for lumbosacral radicular pain.

Interventions

Not applicable.

Main Outcome Measures

Pain reduction from preinjection to 2-week follow-up was measured by visual analog scale (VAS). Patients were grouped by those who experienced no pain relief or worsened pain (≤0%), pain relief but <50% relief (>0%–<50%), or significant pain relief (≥50%) on the VAS.

Results

The mean duration of pain prior to injection was 45.8±81 weeks. The mean time to follow-up after TFESI was 20±14.2 days. Significantly more patients who experienced ≥50% pain relief at follow-up reported higher preinjection pain on the VAS (P=.0001) and McGill Pain Inventory Questionnaire (P=.0358), reported no worsening of their pain with walking (P=.0161), or had a positive femoral stretch test (P=.0477). No significant differences were found between VAS pain reduction and all other demographic and clinical factors, including a radiologic diagnosis of disk herniation versus stenosis or other neural tension signs on physical examination.

Conclusions

Greater baseline pain on the VAS and McGill Pain Inventory, a history of a lack of worsening pain with walking, and a positive femoral stretch test predict a greater likelihood of pain reduction after TFESI for lumbosacral radicular pain at short-term follow-up. Greater baseline pain on the McGill Pain Inventory and a lack of worsening pain with walking predict a magnitude of >50% pain reduction.