Does Pain Score in Response to a Standardized Subcutaneous Local Anesthetic Injection Predict Epidural Steroid Injection Outcomes in Patients with Lumbosacral Radiculopathy? A Prospective Correlational Study. Issue 3 (7th January 2013)

• Record Type: Journal Article
• Authors: Cohen, Steven P.; Mao, Jianren; Vu, To‐Nhu; Strassels, Scott A.; Gupta, Anita; Erdek, Michael A.; Christo, Paul J.; Kurihara, Connie; Griffith, Scott R.; Buckenmaier, Chester C.; Chen, Lucy
• Is Part Of: Pain medicine. Volume 14:Issue 3(2013)
• Page Start: 327
• Page End: 335
• Publication Date: 2013-01-07
• Subjects: Pain -- Periodicals; Pain -- Treatment -- Periodicals; Analgesics -- Periodicals; Pain -- Periodicals; Pain Management -- Periodicals; Douleur -- Périodiques; Douleur -- Traitement -- Périodiques; Analgésiques -- Périodiques; Analgésique; Soulagement de la douleur; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.047205
• DOI: 10.1111/pme.12027
• Languages: English
• ISSNs: 1526-2375

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="pme12027-sec-0001" sec-type="section"> <title>Objective</title> <p>Epidural steroid injections (ESI) are the most commonly performed pain procedures. Despite numerous studies, controversy continues to surround their effectiveness. The purpose of this study is to determine whether a standard, clinical local anesthetic injection can predict outcomes for ESI.</p> </sec> <sec id="pme12027-sec-0002" sec-type="section"> <title>Study Design</title> <p>In this multicenter study, 103 patients received two ESI 2 weeks apart. Prior to their first injection, subjects rated the pain intensity of a standardized subcutaneous (SQ) injection of lidocaine prior to the full dose. Numerical rating scale pain scores were correlated with leg and back pain relief, and functional improvement, through 3‐month follow‐up.</p> </sec> <sec id="pme12027-sec-0003" sec-type="section"> <title>Outcome Measures</title> <p>A composite successful outcome was predetermined to be a ≥2‐point decrease in leg pain score, coupled with a positive global perceived effect.</p> </sec> <sec id="pme12027-sec-0004" sec-type="section"> <title>Results</title> <p>A small but significant relationship was found between SQ pain score and reduction in leg (<italic>r</italic> = −0.21, 95% CI −0.38 to −0.04; <italic>P</italic> = 0.03) and back pain (<italic>r</italic> = −0.22, 95% CI −0.36 to −0.07; <italic>P</italic> = 0.03). Subjects with a positive outcome at 1 month had a mean SQ pain score of 2.5 (SD 1.9) vs 4.1 (SD 2.7) in those with a negative outcome (<italic>P</italic> = 0.04). Subjects with SQ pain scores <4/10 had lower leg and back pain scores than those with pain scores ≥4 at 1‐month (mean 3.2, SD 2.6 vs 5.1, SD 2.7 for leg, <italic>P</italic> < 0.01; mean 3.7, SD 2.6 vs 5.0, SD 3.0 for back, <italic>P</italic> = 0.02) and 3‐month (mean 3.8, SD 2.7 vs 5.2, SD 3.1 for leg, <italic>P</italic> = 0.01; mean 4.0, SD 2.6 vs 4.9, SD 3.1 for back; <italic>P</italic> = 0.14) follow‐up.</p> </sec> <sec id="pme12027-sec-0005" sec-type="section"> <title>Conclusions</title> <p>The results of this study found a weak positive correlation between SQ pain scores and treatment results. Further research should consider whether pain perception in conjunction with other variables might prove to be a reliable predictor for ESI and other procedural outcomes.</p> </sec> </abstract>