title: The Value of Short-Term Pain Relief in Predicting the One-Month Outcome of Lumbar Transforaminal Epidural Steroid Injections.
abstract: BACKGROUND
  Clinical management after epidural steroid injections of patients with radiculopathy secondary to a lumbar disc herniation is uncertain. It is the aim of this study to determine whether short-term alleviation of leg pain after computed tomography-guided transforaminal epidural steroid injections can predict the 1-month outcome.
  
  
  METHODS
  Prospective observational study of 57 patients at a tertiary radiological department. Study components were visual analog scale leg and back pain at baseline, 15, 30, 45 minutes, 1, 2, and 4 hours, on days 1-14, as well as at 1 month. Health-related Quality of Life and functional impairment were assessed with the Short Form-12 and Oswestry Disability Index. Patients who reported >80% persisting leg pain, as well as patients who underwent a second injection or an operation within 1 month, were defined as nonresponders. Logistic regression was used to analyze the effect size of the relationship between >50% pain relief at any given study visit and responder status.
  
  
  RESULTS
  Patients experiencing a >50% pain reduction 4 hours after the injection were 3.38 times as likely to be responders as those experiencing ≤50% pain reduction (odds ratio 3.38, 95% confidence interval 1.07-10.65). The effect decreased between days 1 and 2, reappeared on day 3, was strongest on day 6 (odds ratio 6.87, 95% confidence interval 1.99-23.72), and remained significant until day 14.
  
  
  CONCLUSIONS
  The results of this study can guide physicians in managing patients with lumbar disc herniation: a ≤50% leg pain relief within 1 week after a transforaminal epidural steroid injection predicts an unfavorable 1-month outcome and suggests that other treatment options may be considered.
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. Electronic address: holger.joswig@gmail.com.
authors.forename: Holger
authors.initials: H
authors.lastname: Joswig
authors.affiliation: Department of Radiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Armin
authors.initials: A
authors.lastname: Neff
authors.affiliation: ZHAW School of Applied Psychology, Zurich, Switzerland.
authors.forename: Christina
authors.initials: C
authors.lastname: Ruppert
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hildebrandt
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Martin Nikolaus
authors.initials: MN
authors.lastname: Stienen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007278:Injections, Spinal / Q000379:methods*; D016015:Logistic Models; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D011446:Prospective Studies; D011843:Radiculopathy / Q000188:drug therapy*; D013256:Steroids / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics; D013256:Steroids
keywords: Back pain; Lumbar disc herniation; Nerve root; Radicular pain; Tranforaminal epidural steroid injection