title: Low back pain patients unresponsive to an epidural steroid injection: identifying predictive factors.
abstract: This study examined factors that help to identify low back pain patients who do not benefit from a lumbar epidural steroid injection (LESI). Two-hundred and forty-nine chronic low back pain patients assessed their pain intensity before, 1 day after, and 2 weeks after receiving a LESI. All patients completed a comprehensive pain questionnaire and a Brief Symptom Inventory (BSI) prior to treatment. Diagnosis and extent of pathology were independently assessed by two physicians. One-hundred and thirty-one patients (52.6%) were followed 1 year after treatment. Results showed that average pain intensity ratings decreased in 62.3% of patients 2 weeks after receiving a LESI. One year after treatment, 62.6% felt that LESI was helpful. Nine patients (7%) felt that the treatment was harmful. Four factors were identified that best predicted poor outcome 2 weeks after LESI: (a) greater number of previous treatments for pain; (b) more medications taken; (c) pain not necessarily increased by activities, and (d) pain increased by coughing. Factors that predicted no benefit 1 year after treatment included (a) pain does not interfere with activities; (b) unemployment due to pain; (c) normal straight-leg raise test prior to treatment; and (d) pain not decreased by medication.
authors.affiliation: Department of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts 02115.
authors.forename: R N
authors.initials: RN
authors.lastname: Jamison
authors.forename: T
authors.initials: T
authors.lastname: VadeBoncouer
authors.forename: F M
authors.initials: FM
authors.lastname: Ferrante
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D001416:Back Pain / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011379:Prognosis; D012044:Regression Analysis; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D013256:Steroids