You are here

  • Home
  • Online First
  • Multicenter study evaluating factors associated with treatment outcome for low back pain injections

Article Text

Article menu

other Versions

Download PDFPDF
Original research
Multicenter study evaluating factors associated with treatment outcome for low back pain injections
  1. Steven P Cohen1,2,
  2. Tina L Doshi1,
  3. Connie Kurihara3,
  4. David Reece3,
  5. Edward Dolomisiewicz3,
  6. Christopher R Phillips4,
  7. Timothy Dawson5,
  8. David Jamison6,
  9. Ryan Young7 and
  10. Paul F Pasquina3
  1. 1Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2Departments of Physical Medicine & Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  3. 3Department of Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  4. 4Department of Anesthesiology, Naval Hospital San Diego, San Diego, California, USA
  5. 5Department of Anesthesiology, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
  6. 6Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  7. 7Department of Surgery, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
  1. Correspondence to Dr Steven P Cohen, Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; scohen40{at}jhmi.edu

Abstract

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
  • injections
  • spinal

Data availability statement

Data are available on reasonable request. Deidentified data will be available on reasonable request.

https://doi.org/10.1136/rapm-2021-103247

Statistics from Altmetric.com

    Request Permissions

    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.

    Data availability statement

    Data are available on reasonable request. Deidentified data will be available on reasonable request.

    View Full Text

    Footnotes

    • Twitter @dr_tinadoshi

    • 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.