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

Steven P. Cohen, Jianren Mao, To Nhu Vu, Scott A. Strassels, Anita Gupta, Michael A. Erdek, Paul J. Christo, Connie Kurihara, Scott R. Griffith, Chester C. Buckenmaier, Lucy Chen

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: 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. Study Design: 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. Outcome Measures: A composite successful outcome was predetermined to be a ≥2-point decrease in leg pain score, coupled with a positive global perceived effect. Results: A small but significant relationship was found between SQ pain score and reduction in leg (r=-0.21, 95% CI -0.38 to -0.04; P=0.03) and back pain (r=-0.22, 95% CI -0.36 to -0.07; P=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 (P=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, P<0.01; mean 3.7, SD 2.6 vs 5.0, SD 3.0 for back, P=0.02) and 3-month (mean 3.8, SD 2.7 vs 5.2, SD 3.1 for leg, P=0.01; mean 4.0, SD 2.6 vs 4.9, SD 3.1 for back; P=0.14) follow-up. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)327-335
Number of pages9
JournalPain Medicine (United States)
Volume14
Issue number3
DOIs
StatePublished - Mar 2013

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Epidural Injections
Radiculopathy
Local Anesthetics
Steroids
Prospective Studies
Pain
Injections
Leg
Back Pain
Pain Perception
Subcutaneous Injections
Lidocaine
Low Back Pain
Multicenter Studies
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

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. / 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. In: Pain Medicine (United States). 2013 ; Vol. 14, No. 3. pp. 327-335.
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title = "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",
abstract = "Objective: 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. Study Design: 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. Outcome Measures: A composite successful outcome was predetermined to be a ≥2-point decrease in leg pain score, coupled with a positive global perceived effect. Results: A small but significant relationship was found between SQ pain score and reduction in leg (r=-0.21, 95{\%} CI -0.38 to -0.04; P=0.03) and back pain (r=-0.22, 95{\%} CI -0.36 to -0.07; P=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 (P=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, P<0.01; mean 3.7, SD 2.6 vs 5.0, SD 3.0 for back, P=0.02) and 3-month (mean 3.8, SD 2.7 vs 5.2, SD 3.1 for leg, P=0.01; mean 4.0, SD 2.6 vs 4.9, SD 3.1 for back; P=0.14) follow-up. Conclusions: 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.",
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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. / 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.

In: Pain Medicine (United States), Vol. 14, No. 3, 03.2013, p. 327-335.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 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

AU - Cohen, Steven P.

AU - Mao, Jianren

AU - Vu, To Nhu

AU - Strassels, Scott A.

AU - Gupta, Anita

AU - Erdek, Michael A.

AU - Christo, Paul J.

AU - Kurihara, Connie

AU - Griffith, Scott R.

AU - Buckenmaier, Chester C.

AU - Chen, Lucy

PY - 2013/3

Y1 - 2013/3

N2 - Objective: 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. Study Design: 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. Outcome Measures: A composite successful outcome was predetermined to be a ≥2-point decrease in leg pain score, coupled with a positive global perceived effect. Results: A small but significant relationship was found between SQ pain score and reduction in leg (r=-0.21, 95% CI -0.38 to -0.04; P=0.03) and back pain (r=-0.22, 95% CI -0.36 to -0.07; P=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 (P=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, P<0.01; mean 3.7, SD 2.6 vs 5.0, SD 3.0 for back, P=0.02) and 3-month (mean 3.8, SD 2.7 vs 5.2, SD 3.1 for leg, P=0.01; mean 4.0, SD 2.6 vs 4.9, SD 3.1 for back; P=0.14) follow-up. Conclusions: 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.

AB - Objective: 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. Study Design: 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. Outcome Measures: A composite successful outcome was predetermined to be a ≥2-point decrease in leg pain score, coupled with a positive global perceived effect. Results: A small but significant relationship was found between SQ pain score and reduction in leg (r=-0.21, 95% CI -0.38 to -0.04; P=0.03) and back pain (r=-0.22, 95% CI -0.36 to -0.07; P=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 (P=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, P<0.01; mean 3.7, SD 2.6 vs 5.0, SD 3.0 for back, P=0.02) and 3-month (mean 3.8, SD 2.7 vs 5.2, SD 3.1 for leg, P=0.01; mean 4.0, SD 2.6 vs 4.9, SD 3.1 for back; P=0.14) follow-up. Conclusions: 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.

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