Multicenter study evaluating factors associated with treatment outcome for low back pain injections

Abstract

BackgroundThere has been a worldwide surge in interventional procedures for low back pain (LBP), with studies yielding mixed results. These data support the need for identifying outcome predictors based on unique characteristics in a pragmatic setting.MethodsWe prospectively evaluated the association between over two dozen demographic, clinical and technical factors on treatment outcomes for three procedures: epidural steroid injections (ESIs) for sciatica, and sacroiliac joint (SIJ) injections and facet interventions for axial LBP. The primary outcome was change in patient-reported average pain intensity on a numerical rating scale (average NRS-PI) using linear regression. For SIJ injections and facet radiofrequency ablation, this was average LBP score at 1 and 3 months postprocedure, respectively. For ESI, it was average leg pain 1- month postinjection. Secondary outcomes included a binary indicator of treatment response (success).Results346 patients were enrolled at seven hospitals. All groups experienced a decrease in average NRS-PI (p<0.0001; mean 1.8±2.6). There were no differences in change in average NRS-PI among procedural groups (p=0.50). Lower baseline pain score (adjusted coefficient −0.32, 95% CI −0.48 to −0.16, p<0.0001), depressive symptomatology (adjusted coefficient 0.076, 95% CI 0.039 to 0.113, p<0.0001) and obesity (adjusted coefficient 0.62, 95% CI 0.038 to 1.21, p=0.037) were associated with smaller pain reductions. For procedural outcome, depression (adjusted OR 0.94, 95% CI 0.91, 0.97, p<0.0001) and poorer baseline function (adjusted OR 0.59, 95% CI 0.36, 0.96, p=0.034) were associated with failure. Smoking, sleep dysfunction and non-organic signs were associated with negative outcomes in univariate but not multivariate analyses.ConclusionsIdentifying treatment responders is a critical endeavor for the viability of procedures in LBP. Patients with greater disease burden, depression and obesity are more likely to fail interventions. Steps to address these should be considered before or concurrent with procedures as considerations dictate.Trial registration numberNCT02329951.

Comparative effectiveness of electroacupuncture VS neuromuscular electrical stimulation in the treatment of chronic low back pain in active-duty personals: A single-center, randomized control study

“…Interestingly, in logistic regression, baseline pain intensity seems to be associated with immediate treatment effect; yet in the linear regression analysis, baseline NRS score is correlated with reduced pain score in almost all follow-ups. As a matter of fact, both of these variables are generally accepted as the main indicative symptoms and predictive factors in predicting treatment effects for chronic LBP, as higher NRS score indicates pain catastrophizing, and FABQ reflects the fear-avoidance beliefs ( 26 ). Fear-avoidance belief is a psychological assessment that details an individual's fear of pain and re-injury specific to LBP.…”

“…The primary outcome measure is a change in average pain score (NRS) and treatment satisfaction scale (Likert), and the primary end point is 1 day after the treatment diagram, and 4-weeks and 12-weeks follow-up. A positive categorical response to the treatment is defined as a two-point or greater decrease in the NRS score and a score of > 3 on the Likert scale, according to previous studies ( 26 ). Thus, a positive rate for treatment is then achieved in each group, and changes in NRS scores are also calculated.…”

A Retrospective Study on Patient-Specific Predictors for Non-Response to Sacroiliac Joint Injections

“…Many of the patient-specific predictors in this study have not been studied directly in the context of only SIJ pain and treatment. A recent study by Cohen et al [ 16 ] studying the effects of demographic variables on response to either epidural steroid injections, SIJ injections, and facet interventions for axial LBP revealed lower baseline pain score, depressive symptomatology, and obesity were associated with smaller pain outcomes. Our study reflects the effects of patient-specific predictors for SIJ injections alone, which may account for the differences in our results as well as the similarities with regard to depressive symptoms.…”

Radiofrequency Ablation as an Effective Long-Term Treatment for Chronic Sacroiliac Joint Pain: A Systematic Review of Randomized Controlled Trials

“…This dimension has not been explored in other research to our knowledge. Specifically, the treatment was more likely to fail in patients presenting with obesity, depression, and other disease comorbidities [15].…”

“…Terao et al investigated SIJ pain in patients with kyphoscoliosis [27]. It is worth emphasizing the importance of identifying "responders" that were brought forth by Cohen [15], as pre-existing conditions and medical history likely play a critical role in the outcome of any intervention. Terao investigated 22 anatomical sites from 16 patients, randomized into treatment (RFA + facet joint denervation) or control (facet joint denervation alone).…”