Pain reproduction during lumbosacral transforaminal epidural steroid injection does not affect outcome

Abstract

Objective:

Epidural steroid injections (ESIs) are widely used in clinical practice for the treatment of low back radicular pain. Anecdotally it has been conveyed that the reproduction of a patient’s usual pain during ESI was of prognostic value as to which patients would show favorable results from the procedure, however, there is no data available to support this supposition.

Design:

Retrospective.

Setting:

Outpatient Spine and Sports Medicine Clinic.

Patients:

Patients with lumbosacral radicular pain treated with fluoroscopically guided contrast enhanced lumbosacral transforaminal ESI.

Outcome Measures:

11-point pain intensity numeric rating scale (PI-NRS).

Results:

Overall the procedure provided statistically significant pain relief in both groups A (typical radicular pain reproduced) and B (typical radicular pain not reproduced) immediately and significant pain reduction was maintained until the time of the follow-up No reduction in pain was seen in group A vs. B, although in group B there was a strong trend toward having higher pain scores at all times.

Conclusion:

The reproduction of a patient’s typical radicular pain during a fluoroscopically guided contrast enhanced lumbosacral transforaminal ESI does not predict a significant decrease in pain scores immediately after the procedure or at follow up.