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Factors associated with pain reduction after transforaminal epidural steroid injection for lumbosacral radicular pain



Factors associated with pain reduction after transforaminal epidural steroid injection for lumbosacral radicular pain



Archives of Physical Medicine and Rehabilitation 95(12): 2350-2356



To identify demographic and clinical factors associated with pain improvement after a lumbosacral transforaminal epidural steroid injection (TFESI) for the treatment of radicular pain. Retrospective cohort study. Outpatient center. Adults (N=188) who underwent a fluoroscopically guided TFESI for lumbosacral radicular pain. Not applicable. Pain reduction from preinjection to 2-week follow-up was measured by visual analog scale (VAS). Patients were grouped by those who experienced no pain relief or worsened pain (≤0%), pain relief but <50% relief (>0%-<50%), or significant pain relief (≥50%) on the VAS. The mean duration of pain prior to injection was 45.8±81 weeks. The mean time to follow-up after TFESI was 20±14.2 days. Significantly more patients who experienced ≥50% pain relief at follow-up reported higher preinjection pain on the VAS (P=.0001) and McGill Pain Inventory Questionnaire (P=.0358), reported no worsening of their pain with walking (P=.0161), or had a positive femoral stretch test (P=.0477). No significant differences were found between VAS pain reduction and all other demographic and clinical factors, including a radiologic diagnosis of disk herniation versus stenosis or other neural tension signs on physical examination. Greater baseline pain on the VAS and McGill Pain Inventory, a history of a lack of worsening pain with walking, and a positive femoral stretch test predict a greater likelihood of pain reduction after TFESI for lumbosacral radicular pain at short-term follow-up. Greater baseline pain on the McGill Pain Inventory and a lack of worsening pain with walking predict a magnitude of >50% pain reduction.

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Accession: 053193915

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PMID: 25108099

DOI: 10.1016/j.apmr.2014.07.404


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