Pain reproduction during lumbosacral transforaminal epidural steroid injection does not affect outcome

Article type: Research Article

Authors: Plastaras, Christopher T.^a | Heller, Daniel S.^{b; *} | Sorosky, Brad S.^{a; 1} | Houle, Timothy T.^{c; 2}

Affiliations: [a] Spine and Sports Rehabilitation Center, 1030 North Clark Street #500, Chicago, IL 60610, USA | [b] Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, IL 60610, USA | [c] Center for Pain Studies, Rehabilitation Institute of Chicago, 446 East Ontario Street, Suite 1011, Chicago, IL 60611, USA

Correspondence: [*] Address for correspondence: Daniel S. Heller, MD, 40 East 9th Street #803, Chicago, IL 60605, USA. Tel.: +1 312 431 1869; E-mail: dheller@ric.org

Note: [1] Current Affiliation: Desert Pain Institute, 6309 E. Baywood, Mesa, AZ 85206, USA.

Note: [2] Current Affiliation: Department of Anesthesiology, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157-000, USA.

Abstract: Objective:Epidural steroid injections (ESIs) are widely used in clinical practice for the treatment of low back radicular pain. Anecdotally it has been conveyed that the reproduction of a patient’s usual pain during ESI was of prognostic value as to which patients would show favorable results from the procedure, however, there is no data available to support this supposition. Design:Retrospective. Setting:Outpatient Spine and Sports Medicine Clinic. Patients:Patients with lumbosacral radicular pain treated with fluoroscopically guided contrast enhanced lumbosacral transforaminal ESI. Outcome Measures:11-point pain intensity numeric rating scale (PI-NRS). Results:Overall the procedure provided statistically significant pain relief in both groups A (typical radicular pain reproduced) and B (typical radicular pain not reproduced) immediately and significant pain reduction was maintained until the time of the follow-up No reduction in pain was seen in group A vs. B, although in group B there was a strong trend toward having higher pain scores at all times. Conclusion:The reproduction of a patient’s typical radicular pain during a fluoroscopically guided contrast enhanced lumbosacral transforaminal ESI does not predict a significant decrease in pain scores immediately after the procedure or at follow up.

Keywords: Transforaminal, epidural steroid injection, predictive outcome, low back pain, radicular pain

DOI: 10.3233/BMR-2006-192-303

Journal: Journal of Back and Musculoskeletal Rehabilitation, vol. 19, no. 2-3, pp. 57-60, 2006