title: Lumbar transforaminal epidural steroid injections: does immediate post-procedure pain response predict longer term effectiveness?
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.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Single academic radiology practice.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, American University of Beirut, Beirut, Lebanon.
authors.forename: Christine
authors.initials: C
authors.lastname: El-Yahchouchi
authors.forename: John
authors.initials: J
authors.lastname: Wald
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Brault
authors.forename: Jennifer
authors.initials: J
authors.lastname: Geske
authors.forename: Clinton
authors.initials: C
authors.lastname: Hagen
authors.forename: Naveen
authors.initials: N
authors.lastname: Murthy
authors.forename: Timothy
authors.initials: T
authors.lastname: Kaufmann
authors.forename: Kent
authors.initials: K
authors.lastname: Thielen
authors.forename: Jonathan
authors.initials: J
authors.lastname: Morris
authors.forename: Felix
authors.initials: F
authors.lastname: Diehn
authors.forename: Kimberly
authors.initials: K
authors.lastname: Amrami
authors.forename: Rickey
authors.initials: R
authors.lastname: Carter
authors.forename: Randy
authors.initials: R
authors.lastname: Shelerud
authors.forename: Timothy
authors.initials: T
authors.lastname: Maus
mesh_terms: D000368:Aged; D001416:Back Pain / Q000175:diagnosis / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007268:Injections, Epidural; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects* / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D013256:Steroids
keywords: Immediate Response; Longer Term Effectiveness; Lumbar Transforaminal Epidural Steroid Injection