Kim Ho-Joong, Yeom Jin S, Lee Joon Woo, Chang Bong-Soon, Lee Choon-Ki, Lee Gun-Woo, Im Seung-Bin, Kim Han Jo
Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sung-Nam, Korea.
Pain Pract. 2014 Jun;14(5):405-12. doi: 10.1111/papr.12084. Epub 2013 Jun 5.
The aim of this study was to investigate the effect of individual pain sensitivity on the results of transforaminal epidural steroid injection (TFESI) for the patients with lumbar spinal stenosis (LSS). Seventy-seven patients with LSS were included in this study. Prospectively planned evaluations were performed twice consecutively before and 2 months after TFESI. These included a detailed medical history, a physical examination, and completion of a series of questionnaires, including pain sensitivity questionnaire (PSQ), Oswestry disability index (ODI), and visual analog scale (VAS) for back and leg pain. The correlations were analyzed among variables between total PSQ/PSQ-moderate/PSQ-minor and pain and disability level measured by VAS for back/leg pain and ODI both before and 2 months after TFESI. Two months after TFESI, there were significant decreases in VAS for back/leg pain and ODI compared with those before injection. Before injection, VAS for back pain and leg pain was highly associated with the PSQ scores including total PSQ and PSQ subscores after adjustment for age, BMI, and grade of canal stenosis. However, any subscores of PSQ and total PSQ scores were not correlated with either VAS for back pain/leg pain or ODI 2 months after TFESI with adjustment made to age, BMI, gender, and grade of canal stenosis. This study highlights that individual pain sensitivity does not influence the outcomes of TFESI treatment in patients with LSS, even though pain sensitivity has a significant negative correlation with symptom severity of LSS.
本研究的目的是调查个体疼痛敏感性对腰椎管狭窄症（LSS）患者经椎间孔硬膜外类固醇注射（TFESI）结果的影响。本研究纳入了77例LSS患者。在TFESI之前和之后2个月连续进行了两次前瞻性计划评估。这些评估包括详细的病史、体格检查，以及完成一系列问卷，包括疼痛敏感性问卷（PSQ）、Oswestry功能障碍指数（ODI）以及背部和腿部疼痛的视觉模拟量表（VAS）。分析了TFESI之前和之后2个月时，总PSQ/中度PSQ/轻度PSQ与通过背部/腿部疼痛VAS和ODI测量的疼痛及功能障碍水平之间各变量的相关性。TFESI后2个月，与注射前相比，背部/腿部疼痛的VAS和ODI显著降低。注射前，在对年龄、体重指数（BMI）和椎管狭窄程度进行校正后，背部疼痛和腿部疼痛的VAS与包括总PSQ和PSQ子评分在内的PSQ评分高度相关。然而，在对年龄、BMI、性别和椎管狭窄程度进行校正后，TFESI后两个月，PSQ的任何子评分和总PSQ评分均与背部疼痛/腿部疼痛的VAS或ODI无关。本研究强调，尽管疼痛敏感性与LSS的症状严重程度存在显著负相关，但个体疼痛敏感性并不影响LSS患者TFESI治疗的结果。
