906 - The Influence of Psychosocial Factors on Response to Epidural Steroid Injection (ESI) for Chronic Radicular Pain: A Longitudinal Pilot Study

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

Selena Lugosi, B.S.

Medical Student
UT Health San Antonio
Boerne, Texas, United States

Corresponding Author(s)

LL

Luke Lehman, MD

Resident Physician
UT Health San Antonio
San Antonio, Texas, United States

Co-Author(s)

BC

Briana Cobos, PhD

Research Psychologist
University of Texas at San Antonio
San Antonio, Texas, United States
DR

David Reed, II, PhD

Clinical Psychologist
University of Washington
San Antonio, Texas, United States
AN

Ameet Nagpal, MD

Division Chief, Physical Medicine & Rehabilitation
Medical University of South Carolina
San Antonio, Texas, United States
CM

Cindy McGeary, PhD

Associate Professor
UT Health San Antonio
San Antonio, Texas, United States
ME

Maxim Eckmann, MD

Professor
UT Health San Antonio
San Antonio, Texas, United States
TH

Timothy Houle, PhD

Associate Professor of Anesthesia
Harvard Medical School
San Antonio, Texas, United States
DM

Donald McGeary, PhD

Professor
UT Health San Antonio
San Antonio, Texas, United States

Objectives: To better delineate the relationship between non-procedural factors and ESI efficacy.

Design: The study was structured as a longitudinal observation study. Patients with chronic radicular low back pain lasting longer than 3 months who were referred for an ESI were included. Subjects completed several self-report assessments the day of ESI, and follow-up assessments at 6 weeks, 12 weeks, and 6 months post-ESI. Data collected at each assessment included: Numeric Rating Scale of Pain, the Fear Avoidance Beliefs Questionnaire, the Pain Catastrophizing Scale, the Chronic Pain Acceptance Questionnaire, Insomnia Severity Index, Credibility and Expectancy Questionnaire (prior to ESI), 7-Item Generalized Anxiety Disorder Scale, 9-Item Patient Health Questionnaire. A multiple regression was used, with general linear modeling to derive potential pain severity levels at six and 12 weeks. All analyses were completed using SPSS v.26.

Results: Pre-injection levels of pain catastrophizing were significantly correlated with pre-injection pain severity, r (40) = .50, p = .001, as well as 12 weeks post-injection, r (28) = .50, p = .005. Our main outcome of interest was the NRS item related to “pain right now.” Individuals reported an average NRS of 6.63 (SD = 2.18) prior to ESI, and a mean of 5.52 (SD = 3.28) 12 weeks after ESI, representing a decrease of NRS by 1.11. Our hypothesis was supported; with every one unit increase of pain catastrophizing scores pre-injection, NRS scores at 12-weeks post-injection increased by .12 units, a significant relationship, (controlling for baseline levels of pain severity), b = .12, t(28) = 2.98, p = .006, β = .50.

Conclusions: This study demonstrates that non-procedural factors like pain catastrophizing influence the efficacy of epidural steroid injections. Understanding this relationship may help develop predictive models to optimize patient selection and ESI efficacy.