title: The value of short-term pain relief in predicting the 1-month outcome of 'indirect' cervical epidural steroid injections.
abstract: Clinical management after epidural steroid injections (ESI) of patients with radiculopathy secondary to a cervical disc herniation (CDH) is uncertain. This study aims to determine whether short-term arm pain alleviation following computed tomography-guided 'indirect' cervical ESI can predict the 1-month outcome.
  
  
  
  We conducted a prospective observation of 45 consecutive patients at a tertiary radiological department. Study components were visual analog scale arm and neck pain at baseline, 15, 30, and 45 min, 1, 2, and 4 h, on days 1-14, 1 month, and at 1 year. Health-related quality of life and functional impairment were assessed using the short form-12 and Neck Pain and Disability Scale. Patients who reported ≥80 % persisting arm pain, as well as patients who underwent a second injection or an operation within 1 month were defined as 'non-responders'. Logistic regression was used to analyze the effect size of the relationship between >50 % pain relief at any given study visit and responder status.
  
  
  
  Patients experiencing a >50 % pain reduction 4 h after the injection were four times as likely to be responders as those experiencing ≤50 % pain reduction (OR 4.04, 95 % CI 1.10-14.87). The effect was strongest on days 5-6 (OR 18.37, 95 % CI 3.39-99.64) and remained significant until day 14.
  
  
  
  The results of this study can guide physicians in managing patients with CDH: a ≤50 % arm pain relief within 1 week after an 'indirect' cervical ESI predicts an unfavorable 1-month outcome and suggests that other treatment options may be considered at an earlier point in time.
authors: Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland. holger.joswig@gmail.com.
authors: Holger
authors: 0000-0003-3540-3910
authors: H
authors: Joswig
authors: Department of Radiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors: Armin
authors: A
authors: Neff
authors: ZHAW School of Applied Psychology, Zurich, Switzerland.
authors: Christina
authors: C
authors: Ruppert
authors: Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
authors: Gerhard
authors: G
authors: Hildebrandt
authors: Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland.
authors: Martin Nikolaus
authors: MN
authors: Stienen
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000188:drug therapy*; D011843:Radiculopathy / Q000175:diagnosis / Q000188:drug therapy*; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000700:Analgesics; D013256:Steroids
keywords: Arm pain; Cervical disc herniation; Epidural injection; Neck pain; Nerve root; Radicular pain