title: Factors associated with pain reduction after transforaminal epidural steroid injection for lumbosacral radicular pain.
abstract: OBJECTIVE
  To identify demographic and clinical factors associated with pain improvement after a lumbosacral transforaminal epidural steroid injection (TFESI) for the treatment of radicular pain.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Outpatient center.
  
  
  METHODS
  Adults (N=188) who underwent a fluoroscopically guided TFESI for lumbosacral radicular pain.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Northwestern McGaw Medical Center/The Rehabilitation Institute of Chicago, Chicago, IL. Electronic address: zmccormi@gmail.com.
authors.forename: Zachary
authors.initials: Z
authors.lastname: McCormick
authors.affiliation: Department of Physical Medicine and Rehabilitation, Northwestern McGaw Medical Center/The Rehabilitation Institute of Chicago, Chicago, IL.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cushman
authors.affiliation: Department of Physical Medicine and Rehabilitation, Northwestern McGaw Medical Center/The Rehabilitation Institute of Chicago, Chicago, IL.
authors.forename: Ellen
authors.initials: E
authors.lastname: Casey
authors.affiliation: College of Nursing, University of Florida, Gainesville, FL.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Garvan
authors.affiliation: Department of Orthopaedics, Stanford University, Palo Alto, CA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kennedy
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Plastaras
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001623:Betamethasone / Q000008:administration & dosage*; D005267:Femoral Nerve / Q000503:physiopathology; D006801:Humans; D007268:Injections, Epidural; D017116:Low Back Pain / Q000188:drug therapy*; D008161:Lumbosacral Region; D009460:Neurologic Examination; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011843:Radiculopathy / Q000188:drug therapy*; D012720:Severity of Illness Index; D013126:Spinal Nerve Roots; D011795:Surveys and Questionnaires; D014221:Triamcinolone / Q000008:administration & dosage*; D016138:Walking
chemical_list: D000893:Anti-Inflammatory Agents; D014221:Triamcinolone; D001623:Betamethasone
keywords: Back pain; Injections, epidural; Lumbosacral region; Radiculopathy; Rehabilitation