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Relationship of pain relief with catastrophizing following interventional pain procedures for low back pain
  1. Kanishka Rajput1,
  2. Benjamin A Howie2,3,
  3. Julius Araash Danesh4,
  4. Xiwen Zhao1,
  5. Hung-Mo Lin1,
  6. David Yanez5 and
  7. Robert Chow1
  1. 1Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
  2. 2Icahn School of Medicine at Mount Sinai, New York, New York, USA
  3. 3Yale-New Haven Hospital, New Haven, Connecticut, USA
  4. 4Department of Pain Medicine, West Virginia University—Health Sciences Campus, Morgantown, West Virginia, USA
  5. 5Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Kanishka Rajput, Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06510, USA; kanishka.rajput{at}


Introduction Catastrophizing is associated with worse pain outcomes after various procedures suggesting its utility in predicting response. However, the stability of pain catastrophizing as a static predictor has been challenged. We assess, among patients undergoing steroid injections for chronic low back pain (cLBP), whether catastrophizing changes with the clinical response to pain interventions.

Methods This prospective study enrolled patients undergoing fluoroscopic-guided injections for cLBP. Patients filled out Brief Pain Inventory (BPI) and Pain Catastrophizing Scale (PCS) at baseline and 1-month follow-up. We assessed the change in PCS scores from pre-injection to post-injection and examined its predictors. We also examined the correlation of various domains of BPI, such as pain severity and effect on Relationships, Enjoyment, and Mood (REM), with PCS scores at baseline and follow-up.

Results 128 patients were enrolled. Mean (SD) PCS and pain severity scores at baseline were 22.38 (±13.58) and 5.56 (±1.82), respectively. Follow-up PCS and pain severity scores were 19.76 (±15.25) and 4.42 (±2.38), respectively. The change in PCS pre-injection to post-injection was not significant (p=0.12). Multiple regression models revealed baseline PCS and REM domain of BPI as the most important predictors of change in PCS after injection. Pain severity, activity-related pain, age, sex, insurance status, depression, prior surgery, opioid use, or prior interventions did not predict change in PCS score. In correlation analysis, change in PCS was moderately correlated with change in pain (r=0.38), but weakly correlated with baseline pain in all pain domains.

Conclusions PCS showed non-significant improvement following steroid injections; the study was not powered for this outcome. Follow-up PCS scores were predicted by the REM domain of BPI, rather than pain severity. Larger studies are needed to evaluate a statistically significant and clinically meaningful change in catastrophizing scores following pain interventions.

  • back pain
  • chronic pain
  • injections, spinal

Data availability statement

Data are available on reasonable request. De-identified patient data are available on reasonable request.

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Data availability statement

Data are available on reasonable request. De-identified patient data are available on reasonable request.

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  • Contributors All authors helped with study design, data collection, data analysis, and manuscript preparation. KR acts as guranator.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.