Background There has been a worldwide surge in interventional procedures for low back pain (LBP), with studies yielding mixed results. These data support the need for identifying outcome predictors based on unique characteristics in a pragmatic setting.
Methods We prospectively evaluated the association between over two dozen demographic, clinical and technical factors on treatment outcomes for three procedures: epidural steroid injections (ESIs) for sciatica, and sacroiliac joint (SIJ) injections and facet interventions for axial LBP. The primary outcome was change in patient-reported average pain intensity on a numerical rating scale (average NRS-PI) using linear regression. For SIJ injections and facet radiofrequency ablation, this was average LBP score at 1 and 3 months postprocedure, respectively. For ESI, it was average leg pain 1- month postinjection. Secondary outcomes included a binary indicator of treatment response (success).
Results 346 patients were enrolled at seven hospitals. All groups experienced a decrease in average NRS-PI (p<0.0001; mean 1.8±2.6). There were no differences in change in average NRS-PI among procedural groups (p=0.50). Lower baseline pain score (adjusted coefficient −0.32, 95% CI −0.48 to −0.16, p<0.0001), depressive symptomatology (adjusted coefficient 0.076, 95% CI 0.039 to 0.113, p<0.0001) and obesity (adjusted coefficient 0.62, 95% CI 0.038 to 1.21, p=0.037) were associated with smaller pain reductions. For procedural outcome, depression (adjusted OR 0.94, 95% CI 0.91, 0.97, p<0.0001) and poorer baseline function (adjusted OR 0.59, 95% CI 0.36, 0.96, p=0.034) were associated with failure. Smoking, sleep dysfunction and non-organic signs were associated with negative outcomes in univariate but not multivariate analyses.
Conclusions Identifying treatment responders is a critical endeavor for the viability of procedures in LBP. Patients with greater disease burden, depression and obesity are more likely to fail interventions. Steps to address these should be considered before or concurrent with procedures as considerations dictate.
Trial registration number NCT02329951.
- back pain
- pain management
- chronic pain
Data availability statement
Data are available on reasonable request. Deidentified data will be available on reasonable request.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Contributors Study design: SPC. Drafting manuscript: SPC, TLD and CK. IRB submission and progress reports, enrolling and treating patients and critical evaluation of manuscript: all authors. Funding: PFP and SPC. Guarantor: SPC
Funding Funded in part by a grant from MIRROR, Uniformed Services University of the Health Sciences, US Department of Defense, grant # HU00011920011.
Disclaimer The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Departments of Army and Navy, Department of Defense or US Government. The identification of specific products or scientific instrumentation is considered an integral part of the scientific endeavor and does not constitute endorsement or implied endorsement on the part of the authors, DoD or any component agency. The views expressed in this article those of the authors and do not reflect the official policy of the Departments of Army and Navy, Department of Defense or US Government.
Competing interests SPC: consulting work in past 3 years for Avanos, SPR Therapeutics, Persica, Scilex and Relieviate.
Provenance and peer review Not commissioned; externally peer reviewed.