Lumbar transforaminal epidural steroid injections: does immediate post-procedure pain response predict longer term effectiveness?
| Autor: | Kimberly K. Amrami, John T. Wald, Kent R. Thielen, Jonathan M. Morris, Timothy J. Kaufmann, Christine A. El-Yahchouchi, Jeffrey S. Brault, Felix E. Diehn, Timothy P. Maus, Naveen S. Murthy, Rickey E. Carter, Jennifer R. Geske, Randy A. Shelerud, Clinton E. Hagen |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Weakness Time Factors medicine.medical_treatment Injections Epidural Cohort Studies Lumbar Rating scale Predictive Value of Tests Medicine Humans Aged Pain Measurement Retrospective Studies Lumbar Vertebrae business.industry Epidural steroid injection Retrospective cohort study General Medicine Middle Aged humanities Confidence interval Blockade Anesthesiology and Pain Medicine Treatment Outcome Roland Morris Disability Questionnaire Back Pain Anesthesia Physical therapy Female Steroids Neurology (clinical) medicine.symptom business Follow-Up Studies |
| Zdroj: | Pain medicine (Malden, Mass.). 15(6) |
| ISSN: | 1526-4637 |
| Popis: | Objective To assess whether the immediate anesthetic response of pain relief (sensory blockade) or weakness (motor blockade) after lumbar transforaminal epidural steroid injection (TFESI) is associated with longer term effectiveness in pain relief and functional recovery. Design Retrospective observational study. Setting Single academic radiology practice. Subjects Three thousand six hundred forty-five lumbar TFESIs performed on 2,634 subjects. Methods Subjects completed a pain numerical rating scale (NRS, 0–10) and Roland–Morris disability questionnaire (R-M) prior to and immediately after TFESI (NRS) and at 2 weeks and 2 months follow-up. Successful pain relief was ≥50% NRS reduction; functional success was ≥40% R-M reduction. Post-procedure motor weakness was recorded. Logistic regression models assessed association of immediate post-procedure NRS response, and NRS or R-M response at 2 weeks, with successful outcomes at 2 months. C-index assessed model discrimination; values closer to 1.0 indicated better discrimination. Results Immediate NRS response was weakly associated with 2-month outcomes (C-index = 0.58). NRS and R-M responses at 2 weeks were more strongly associated with the 2-month response (C-indices 0.77, 0.80, respectively). Post-procedure motor blockade had little association with successful 2-month NRS or R-M outcomes (C-indices 0.51, 0.50, respectively). Patients that responded at 2 weeks were more likely to be responders at 2 months than those who were non-responders at 2 weeks (odds ratio = 6.49, confidence interval 5.38, 7.84). Conclusion Immediate post-TFESI pain relief does not strongly predict longer term effectiveness in pain relief or functional recovery. Response in pain relief or functional recovery at 2 weeks is more strongly associated with 2-month outcomes. |
| Databáze: | OpenAIRE |
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