Clinical effectiveness of single lumbar transforaminal epidural steroid injections

Timothy J Kaufmann, Jennifer R. Geske, Naveen S Murthy, Kent R. Thielen, Jonathan M. Morris, John T. Wald, Felix E. Diehn, Kimberly K. Amrami, Rickey E. Carter, Randy A. Shelerud, Ralph Gay, Timothy Maus

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objectives.: To assess the clinical effectiveness of single lumbar transforaminal epidural steroid injections (TFESIs) in subjects with radicular pain with or without radiculopathy. Design.: Retrospective observational series. Setting.: Single academic radiology pain management practice. Subjects.: Two thousand twenty-four subjects undergoing single lumbar TFESIs at the L4-5, L5-S1, or S1 neural foramina. Methods / Outcome Measures.: Subjects were assessed with a pain numerical rating scale (NRS, 0-10) and Roland-Morris disability questionnaire (R-M, 23-point Deyo modification) prior to TFESI and at 2 weeks and 2 months follow-up. Successful pain relief (responders) was defined as either ≥50% reduction in NRS or pain 0/10; functional success was defined as ≥40% reduction in R-M score. Results.: There were statistically significant (P<0.0001) reductions in mean NRS and R-M scores at 2 weeks and 2 months postinjection. For NRS, 40.9% were responders at 2 weeks and 45.6% at 2 months. For R-M, 31.9% were responders at 2 weeks and 41.3% at 2 months. The proportion of responders for NRS and R-M was higher when there was <3 months of pain (odds ratio 2-month NRS=2.42 [95% confidence interval: 1.82, 3.24], odds ratio 2-month R-M=2.61 [1.96, 3.48]). For subjects with <3 months of pain, the proportion of responders was 62.4% (56.5, 68.3%) for NRS and 59.3% (53.3, 65.3%) for R-M scores. Conclusions.: This retrospective observational study suggests TFESIs are clinically effective in the treatment of lumbar radicular pain. Subjects with a shorter duration of pain are more likely to achieve a successful outcome.

Original languageEnglish (US)
Pages (from-to)1126-1133
Number of pages8
JournalPain Medicine (United States)
Volume14
Issue number8
DOIs
StatePublished - Aug 2013

Fingerprint

Epidural Injections
Steroids
Pain
Odds Ratio
Radiculopathy
Pain Management
Radiology
Observational Studies
Retrospective Studies
Outcome Assessment (Health Care)
Confidence Intervals

Keywords

  • Effectiveness
  • Epidural
  • Lumbar
  • Pain
  • Radicular
  • Spine
  • Steroid

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

Clinical effectiveness of single lumbar transforaminal epidural steroid injections. / Kaufmann, Timothy J; Geske, Jennifer R.; Murthy, Naveen S; Thielen, Kent R.; Morris, Jonathan M.; Wald, John T.; Diehn, Felix E.; Amrami, Kimberly K.; Carter, Rickey E.; Shelerud, Randy A.; Gay, Ralph; Maus, Timothy.

In: Pain Medicine (United States), Vol. 14, No. 8, 08.2013, p. 1126-1133.

Research output: Contribution to journalArticle

Kaufmann, Timothy J ; Geske, Jennifer R. ; Murthy, Naveen S ; Thielen, Kent R. ; Morris, Jonathan M. ; Wald, John T. ; Diehn, Felix E. ; Amrami, Kimberly K. ; Carter, Rickey E. ; Shelerud, Randy A. ; Gay, Ralph ; Maus, Timothy. / Clinical effectiveness of single lumbar transforaminal epidural steroid injections. In: Pain Medicine (United States). 2013 ; Vol. 14, No. 8. pp. 1126-1133.
@article{6d02cf6b89dd4f11bb3d7007704fa129,
title = "Clinical effectiveness of single lumbar transforaminal epidural steroid injections",
abstract = "Objectives.: To assess the clinical effectiveness of single lumbar transforaminal epidural steroid injections (TFESIs) in subjects with radicular pain with or without radiculopathy. Design.: Retrospective observational series. Setting.: Single academic radiology pain management practice. Subjects.: Two thousand twenty-four subjects undergoing single lumbar TFESIs at the L4-5, L5-S1, or S1 neural foramina. Methods / Outcome Measures.: Subjects were assessed with a pain numerical rating scale (NRS, 0-10) and Roland-Morris disability questionnaire (R-M, 23-point Deyo modification) prior to TFESI and at 2 weeks and 2 months follow-up. Successful pain relief (responders) was defined as either ≥50{\%} reduction in NRS or pain 0/10; functional success was defined as ≥40{\%} reduction in R-M score. Results.: There were statistically significant (P<0.0001) reductions in mean NRS and R-M scores at 2 weeks and 2 months postinjection. For NRS, 40.9{\%} were responders at 2 weeks and 45.6{\%} at 2 months. For R-M, 31.9{\%} were responders at 2 weeks and 41.3{\%} at 2 months. The proportion of responders for NRS and R-M was higher when there was <3 months of pain (odds ratio 2-month NRS=2.42 [95{\%} confidence interval: 1.82, 3.24], odds ratio 2-month R-M=2.61 [1.96, 3.48]). For subjects with <3 months of pain, the proportion of responders was 62.4{\%} (56.5, 68.3{\%}) for NRS and 59.3{\%} (53.3, 65.3{\%}) for R-M scores. Conclusions.: This retrospective observational study suggests TFESIs are clinically effective in the treatment of lumbar radicular pain. Subjects with a shorter duration of pain are more likely to achieve a successful outcome.",
keywords = "Effectiveness, Epidural, Lumbar, Pain, Radicular, Spine, Steroid",
author = "Kaufmann, {Timothy J} and Geske, {Jennifer R.} and Murthy, {Naveen S} and Thielen, {Kent R.} and Morris, {Jonathan M.} and Wald, {John T.} and Diehn, {Felix E.} and Amrami, {Kimberly K.} and Carter, {Rickey E.} and Shelerud, {Randy A.} and Ralph Gay and Timothy Maus",
year = "2013",
month = "8",
doi = "10.1111/pme.12122",
language = "English (US)",
volume = "14",
pages = "1126--1133",
journal = "Pain Medicine",
issn = "1526-2375",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - Clinical effectiveness of single lumbar transforaminal epidural steroid injections

AU - Kaufmann, Timothy J

AU - Geske, Jennifer R.

AU - Murthy, Naveen S

AU - Thielen, Kent R.

AU - Morris, Jonathan M.

AU - Wald, John T.

AU - Diehn, Felix E.

AU - Amrami, Kimberly K.

AU - Carter, Rickey E.

AU - Shelerud, Randy A.

AU - Gay, Ralph

AU - Maus, Timothy

PY - 2013/8

Y1 - 2013/8

N2 - Objectives.: To assess the clinical effectiveness of single lumbar transforaminal epidural steroid injections (TFESIs) in subjects with radicular pain with or without radiculopathy. Design.: Retrospective observational series. Setting.: Single academic radiology pain management practice. Subjects.: Two thousand twenty-four subjects undergoing single lumbar TFESIs at the L4-5, L5-S1, or S1 neural foramina. Methods / Outcome Measures.: Subjects were assessed with a pain numerical rating scale (NRS, 0-10) and Roland-Morris disability questionnaire (R-M, 23-point Deyo modification) prior to TFESI and at 2 weeks and 2 months follow-up. Successful pain relief (responders) was defined as either ≥50% reduction in NRS or pain 0/10; functional success was defined as ≥40% reduction in R-M score. Results.: There were statistically significant (P<0.0001) reductions in mean NRS and R-M scores at 2 weeks and 2 months postinjection. For NRS, 40.9% were responders at 2 weeks and 45.6% at 2 months. For R-M, 31.9% were responders at 2 weeks and 41.3% at 2 months. The proportion of responders for NRS and R-M was higher when there was <3 months of pain (odds ratio 2-month NRS=2.42 [95% confidence interval: 1.82, 3.24], odds ratio 2-month R-M=2.61 [1.96, 3.48]). For subjects with <3 months of pain, the proportion of responders was 62.4% (56.5, 68.3%) for NRS and 59.3% (53.3, 65.3%) for R-M scores. Conclusions.: This retrospective observational study suggests TFESIs are clinically effective in the treatment of lumbar radicular pain. Subjects with a shorter duration of pain are more likely to achieve a successful outcome.

AB - Objectives.: To assess the clinical effectiveness of single lumbar transforaminal epidural steroid injections (TFESIs) in subjects with radicular pain with or without radiculopathy. Design.: Retrospective observational series. Setting.: Single academic radiology pain management practice. Subjects.: Two thousand twenty-four subjects undergoing single lumbar TFESIs at the L4-5, L5-S1, or S1 neural foramina. Methods / Outcome Measures.: Subjects were assessed with a pain numerical rating scale (NRS, 0-10) and Roland-Morris disability questionnaire (R-M, 23-point Deyo modification) prior to TFESI and at 2 weeks and 2 months follow-up. Successful pain relief (responders) was defined as either ≥50% reduction in NRS or pain 0/10; functional success was defined as ≥40% reduction in R-M score. Results.: There were statistically significant (P<0.0001) reductions in mean NRS and R-M scores at 2 weeks and 2 months postinjection. For NRS, 40.9% were responders at 2 weeks and 45.6% at 2 months. For R-M, 31.9% were responders at 2 weeks and 41.3% at 2 months. The proportion of responders for NRS and R-M was higher when there was <3 months of pain (odds ratio 2-month NRS=2.42 [95% confidence interval: 1.82, 3.24], odds ratio 2-month R-M=2.61 [1.96, 3.48]). For subjects with <3 months of pain, the proportion of responders was 62.4% (56.5, 68.3%) for NRS and 59.3% (53.3, 65.3%) for R-M scores. Conclusions.: This retrospective observational study suggests TFESIs are clinically effective in the treatment of lumbar radicular pain. Subjects with a shorter duration of pain are more likely to achieve a successful outcome.

KW - Effectiveness

KW - Epidural

KW - Lumbar

KW - Pain

KW - Radicular

KW - Spine

KW - Steroid

UR - http://www.scopus.com/inward/record.url?scp=84882700472&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84882700472&partnerID=8YFLogxK

U2 - 10.1111/pme.12122

DO - 10.1111/pme.12122

M3 - Article

C2 - 23895182

AN - SCOPUS:84882700472

VL - 14

SP - 1126

EP - 1133

JO - Pain Medicine

JF - Pain Medicine

SN - 1526-2375

IS - 8

ER -