Effect of lumbar epidural steroid injection on neuropathic pain: a prospective observational study

IF 3.1 Q2 NEUROSCIENCES

AIMS Neuroscience Pub Date : 2022-01-18 DOI:10.3934/Neuroscience.2022003

Chang Hong Park, S. H. Lee

{"title":"Effect of lumbar epidural steroid injection on neuropathic pain: a prospective observational study","authors":"Chang Hong Park, S. H. Lee","doi":"10.3934/Neuroscience.2022003","DOIUrl":null,"url":null,"abstract":"Background Low back pain (LBP) is caused by disc herniation, spinal stenosis, facet syndrome or etc. This LBP could be either nociceptive or neuropathic pain (NP). In addition, these neuropathic pain is a major contributor to chronic low back pain. It is already known that lumbar epidural steroid injection (ESI) is effective for low back pain, but no study has assessed both nociceptive and neuropathic pain separately. This study investigated whether neuropathic or nociceptive pain was better improved after an epidural steroid injection. Methods This was a prospective study. Patients were classified according to the pre-procedure painDETECT questionnaire (PD-Q) score. If the PD-Q score was ≤12, it was considered as nociceptive pain, and it the PD-Q was ≥19, it was considered NP. The patients were given a transforaminal (TF) or interlaminar (IL) epidural steroid injection (ESI). The PD-Q was filled out by each patient prior to the ESI (baseline), and again at 4 weeks after the ESI. Outcomes was assessed using a numerical rating scale (NRS) score, short form McGill Pain Questionnaire (MPQ), and revised Oswestry Back Disability Index (ODI) at 1 month later. Results A total of 114 patients were enrolled and of these, 54 patients with a PD-Q score of ≤12 were classified into the nociceptive pain, and 60 patients with a PD-Q score ≥19 were classified into the neuropathic pain group. At 1 month after treatment, both groups had significantly lower than improved their mean NRS score. Not withstanding these improvements and difference between NRS, the differences in MPQ and ODI after treatment between the groups (nociceptive vs. neuropathic) not significant. After the procedure (TF-ESI or IL-ESI), the patients in group 1 (PD-Q score ≤12, n = 54) had no change in their PD-Q score. Among the patients in group 2 (pre-treatment PD-Q score ≥19, n = 41), 13 patients moved to a PD-Q score <12 and 15 patients had a PD-Q score of 13–18. Conclusion For the short-term relief of neuropathic pain, ESI was effective for both nociceptive and neuropathic pain, therefore ESI could be treat the try neuropathic pain component in patients with low back pain.","PeriodicalId":7732,"journal":{"name":"AIMS Neuroscience","volume":"9 1","pages":"24 - 30"},"PeriodicalIF":3.1000,"publicationDate":"2022-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"AIMS Neuroscience","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3934/Neuroscience.2022003","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"NEUROSCIENCES","Score":null,"Total":0}

引用次数: 0

Abstract

Background Low back pain (LBP) is caused by disc herniation, spinal stenosis, facet syndrome or etc. This LBP could be either nociceptive or neuropathic pain (NP). In addition, these neuropathic pain is a major contributor to chronic low back pain. It is already known that lumbar epidural steroid injection (ESI) is effective for low back pain, but no study has assessed both nociceptive and neuropathic pain separately. This study investigated whether neuropathic or nociceptive pain was better improved after an epidural steroid injection. Methods This was a prospective study. Patients were classified according to the pre-procedure painDETECT questionnaire (PD-Q) score. If the PD-Q score was ≤12, it was considered as nociceptive pain, and it the PD-Q was ≥19, it was considered NP. The patients were given a transforaminal (TF) or interlaminar (IL) epidural steroid injection (ESI). The PD-Q was filled out by each patient prior to the ESI (baseline), and again at 4 weeks after the ESI. Outcomes was assessed using a numerical rating scale (NRS) score, short form McGill Pain Questionnaire (MPQ), and revised Oswestry Back Disability Index (ODI) at 1 month later. Results A total of 114 patients were enrolled and of these, 54 patients with a PD-Q score of ≤12 were classified into the nociceptive pain, and 60 patients with a PD-Q score ≥19 were classified into the neuropathic pain group. At 1 month after treatment, both groups had significantly lower than improved their mean NRS score. Not withstanding these improvements and difference between NRS, the differences in MPQ and ODI after treatment between the groups (nociceptive vs. neuropathic) not significant. After the procedure (TF-ESI or IL-ESI), the patients in group 1 (PD-Q score ≤12, n = 54) had no change in their PD-Q score. Among the patients in group 2 (pre-treatment PD-Q score ≥19, n = 41), 13 patients moved to a PD-Q score <12 and 15 patients had a PD-Q score of 13–18. Conclusion For the short-term relief of neuropathic pain, ESI was effective for both nociceptive and neuropathic pain, therefore ESI could be treat the try neuropathic pain component in patients with low back pain.

查看原文本刊更多论文

腰段硬膜外注射类固醇治疗神经性疼痛的前瞻性观察研究

背景腰痛（LBP）是由椎间盘突出、椎管狭窄、小关节综合征等引起的。这种LBP可能是伤害性或神经性疼痛（NP）。此外，这些神经性疼痛是慢性腰痛的主要原因。众所周知，腰段硬膜外类固醇注射（ESI）对腰痛有效，但没有研究分别评估伤害性疼痛和神经性疼痛。本研究调查硬膜外注射类固醇后神经性或伤害性疼痛是否得到更好的改善。方法前瞻性研究。根据术前疼痛检测问卷（PD-Q）评分对患者进行分类。如果PD-Q评分≤12，则被认为是伤害性疼痛，如果PD-Q≥19，则被视为NP。患者接受经孔（TF）或层间（IL）硬膜外类固醇注射（ESI）。每个患者在ESI（基线）前填写PD-Q，并在ESI后4周再次填写。1个月后，使用数字评定量表（NRS）评分、简式麦吉尔疼痛问卷（MPQ）和修订的奥斯韦斯特里背部残疾指数（ODI）评估结果。结果共有114名患者入选，其中54名PD-Q评分≤12的患者被归类为伤害性疼痛，60名PD-Q得分≥19的患者被分类为神经性疼痛组。在治疗后1个月，两组的平均NRS评分均显著低于改善水平。尽管有这些改善和NRS之间的差异，但两组治疗后MPQ和ODI的差异（伤害性与神经性）并不显著。手术后（TF-ESI或IL-ESI），第1组患者（PD-Q评分≤12，n=54）的PD-Q评分没有变化。在第2组的患者中（治疗前PD-Q评分≥19，n=41），13名患者的PD-Q评分<12，15名患者的PD-Q评分为13-18。结论ESI对于神经性疼痛的短期缓解，对伤害性疼痛和神经性疼痛都是有效的，因此ESI可以治疗腰痛患者的神经性疼痛成分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

AIMS Neuroscience NEUROSCIENCES-

CiteScore

4.20

自引率

0.00%

发文量

审稿时长

8 weeks

期刊介绍： AIMS Neuroscience is an international Open Access journal devoted to publishing peer-reviewed, high quality, original papers from all areas in the field of neuroscience. The primary focus is to provide a forum in which to expedite the speed with which theoretical neuroscience progresses toward generating testable hypotheses. In the presence of current and developing technology that offers unprecedented access to functions of the nervous system at all levels, the journal is designed to serve the role of providing the widest variety of the best theoretical views leading to suggested studies. Single blind peer review is provided for all articles and commentaries.