Lumbar transforaminal epidural steroid injections: Does immediate post-procedure pain response predict longer term effectiveness?

Christine El-Yahchouchi, John Wald, Jeffrey Brault, Jennifer Geske, Clinton Hagen, Naveen S Murthy, Timothy J Kaufmann, Kent Thielen, Jonathan Morris, Felix Diehn, Kimberly Amrami, Rickey E. Carter, Randy Shelerud, Timothy Maus

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: To assess whether the immediate anesthetic response of pain relief (sensory blockade) or weakness (motor blockade) after lumbar transforaminal epidural steroid injection (TFESI) is associated with longer term effectiveness in pain relief and functional recovery. Design: Retrospective observational study. Setting: Single academic radiology practice. Subjects: Three thousand six hundred forty-five lumbar TFESIs performed on 2,634 subjects. Methods: Subjects completed a pain numerical rating scale (NRS, 0-10) and Roland-Morris disability questionnaire (R-M) prior to and immediately after TFESI (NRS) and at 2 weeks and 2 months follow-up. Successful pain relief was ≥50% NRS reduction; functional success was ≥40% R-M reduction. Post-procedure motor weakness was recorded. Logistic regression models assessed association of immediate post-procedure NRS response, and NRS or R-M response at 2 weeks, with successful outcomes at 2 months. C-index assessed model discrimination; values closer to 1.0 indicated better discrimination. Results: Immediate NRS response was weakly associated with 2-month outcomes (C-index=0.58). NRS and R-M responses at 2 weeks were more strongly associated with the 2-month response (C-indices 0.77, 0.80, respectively). Post-procedure motor blockade had little association with successful 2-month NRS or R-M outcomes (C-indices 0.51, 0.50, respectively). Patients that responded at 2 weeks were more likely to be responders at 2 months than those who were non-responders at 2 weeks (odds ratio=6.49, confidence interval 5.38, 7.84). Conclusion: Immediate post-TFESI pain relief does not strongly predict longer term effectiveness in pain relief or functional recovery. Response in pain relief or functional recovery at 2 weeks is more strongly associated with 2-month outcomes.

Original languageEnglish (US)
Pages (from-to)921-928
Number of pages8
JournalPain Medicine (United States)
Volume15
Issue number6
DOIs
StatePublished - 2014

Fingerprint

Epidural Injections
Steroids
Pain
Logistic Models
Radiology
Observational Studies
Anesthetics
Retrospective Studies
Odds Ratio
Surveys and Questionnaires
Confidence Intervals

Keywords

  • Immediate Response
  • Longer Term Effectiveness
  • Lumbar Transforaminal Epidural Steroid Injection

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Lumbar transforaminal epidural steroid injections : Does immediate post-procedure pain response predict longer term effectiveness? / El-Yahchouchi, Christine; Wald, John; Brault, Jeffrey; Geske, Jennifer; Hagen, Clinton; Murthy, Naveen S; Kaufmann, Timothy J; Thielen, Kent; Morris, Jonathan; Diehn, Felix; Amrami, Kimberly; Carter, Rickey E.; Shelerud, Randy; Maus, Timothy.

In: Pain Medicine (United States), Vol. 15, No. 6, 2014, p. 921-928.

Research output: Contribution to journalArticle

El-Yahchouchi, Christine ; Wald, John ; Brault, Jeffrey ; Geske, Jennifer ; Hagen, Clinton ; Murthy, Naveen S ; Kaufmann, Timothy J ; Thielen, Kent ; Morris, Jonathan ; Diehn, Felix ; Amrami, Kimberly ; Carter, Rickey E. ; Shelerud, Randy ; Maus, Timothy. / Lumbar transforaminal epidural steroid injections : Does immediate post-procedure pain response predict longer term effectiveness?. In: Pain Medicine (United States). 2014 ; Vol. 15, No. 6. pp. 921-928.
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abstract = "Objective: To assess whether the immediate anesthetic response of pain relief (sensory blockade) or weakness (motor blockade) after lumbar transforaminal epidural steroid injection (TFESI) is associated with longer term effectiveness in pain relief and functional recovery. Design: Retrospective observational study. Setting: Single academic radiology practice. Subjects: Three thousand six hundred forty-five lumbar TFESIs performed on 2,634 subjects. Methods: Subjects completed a pain numerical rating scale (NRS, 0-10) and Roland-Morris disability questionnaire (R-M) prior to and immediately after TFESI (NRS) and at 2 weeks and 2 months follow-up. Successful pain relief was ≥50{\%} NRS reduction; functional success was ≥40{\%} R-M reduction. Post-procedure motor weakness was recorded. Logistic regression models assessed association of immediate post-procedure NRS response, and NRS or R-M response at 2 weeks, with successful outcomes at 2 months. C-index assessed model discrimination; values closer to 1.0 indicated better discrimination. Results: Immediate NRS response was weakly associated with 2-month outcomes (C-index=0.58). NRS and R-M responses at 2 weeks were more strongly associated with the 2-month response (C-indices 0.77, 0.80, respectively). Post-procedure motor blockade had little association with successful 2-month NRS or R-M outcomes (C-indices 0.51, 0.50, respectively). Patients that responded at 2 weeks were more likely to be responders at 2 months than those who were non-responders at 2 weeks (odds ratio=6.49, confidence interval 5.38, 7.84). Conclusion: Immediate post-TFESI pain relief does not strongly predict longer term effectiveness in pain relief or functional recovery. Response in pain relief or functional recovery at 2 weeks is more strongly associated with 2-month outcomes.",
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AU - El-Yahchouchi, Christine

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AU - Brault, Jeffrey

AU - Geske, Jennifer

AU - Hagen, Clinton

AU - Murthy, Naveen S

AU - Kaufmann, Timothy J

AU - Thielen, Kent

AU - Morris, Jonathan

AU - Diehn, Felix

AU - Amrami, Kimberly

AU - Carter, Rickey E.

AU - Shelerud, Randy

AU - Maus, Timothy

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N2 - Objective: To assess whether the immediate anesthetic response of pain relief (sensory blockade) or weakness (motor blockade) after lumbar transforaminal epidural steroid injection (TFESI) is associated with longer term effectiveness in pain relief and functional recovery. Design: Retrospective observational study. Setting: Single academic radiology practice. Subjects: Three thousand six hundred forty-five lumbar TFESIs performed on 2,634 subjects. Methods: Subjects completed a pain numerical rating scale (NRS, 0-10) and Roland-Morris disability questionnaire (R-M) prior to and immediately after TFESI (NRS) and at 2 weeks and 2 months follow-up. Successful pain relief was ≥50% NRS reduction; functional success was ≥40% R-M reduction. Post-procedure motor weakness was recorded. Logistic regression models assessed association of immediate post-procedure NRS response, and NRS or R-M response at 2 weeks, with successful outcomes at 2 months. C-index assessed model discrimination; values closer to 1.0 indicated better discrimination. Results: Immediate NRS response was weakly associated with 2-month outcomes (C-index=0.58). NRS and R-M responses at 2 weeks were more strongly associated with the 2-month response (C-indices 0.77, 0.80, respectively). Post-procedure motor blockade had little association with successful 2-month NRS or R-M outcomes (C-indices 0.51, 0.50, respectively). Patients that responded at 2 weeks were more likely to be responders at 2 months than those who were non-responders at 2 weeks (odds ratio=6.49, confidence interval 5.38, 7.84). Conclusion: Immediate post-TFESI pain relief does not strongly predict longer term effectiveness in pain relief or functional recovery. Response in pain relief or functional recovery at 2 weeks is more strongly associated with 2-month outcomes.

AB - Objective: To assess whether the immediate anesthetic response of pain relief (sensory blockade) or weakness (motor blockade) after lumbar transforaminal epidural steroid injection (TFESI) is associated with longer term effectiveness in pain relief and functional recovery. Design: Retrospective observational study. Setting: Single academic radiology practice. Subjects: Three thousand six hundred forty-five lumbar TFESIs performed on 2,634 subjects. Methods: Subjects completed a pain numerical rating scale (NRS, 0-10) and Roland-Morris disability questionnaire (R-M) prior to and immediately after TFESI (NRS) and at 2 weeks and 2 months follow-up. Successful pain relief was ≥50% NRS reduction; functional success was ≥40% R-M reduction. Post-procedure motor weakness was recorded. Logistic regression models assessed association of immediate post-procedure NRS response, and NRS or R-M response at 2 weeks, with successful outcomes at 2 months. C-index assessed model discrimination; values closer to 1.0 indicated better discrimination. Results: Immediate NRS response was weakly associated with 2-month outcomes (C-index=0.58). NRS and R-M responses at 2 weeks were more strongly associated with the 2-month response (C-indices 0.77, 0.80, respectively). Post-procedure motor blockade had little association with successful 2-month NRS or R-M outcomes (C-indices 0.51, 0.50, respectively). Patients that responded at 2 weeks were more likely to be responders at 2 months than those who were non-responders at 2 weeks (odds ratio=6.49, confidence interval 5.38, 7.84). Conclusion: Immediate post-TFESI pain relief does not strongly predict longer term effectiveness in pain relief or functional recovery. Response in pain relief or functional recovery at 2 weeks is more strongly associated with 2-month outcomes.

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