多中心研究评估与腰痛注射治疗结果相关的因素。
Multicenter study evaluating factors associated with treatment outcome for low back pain injections.
机构信息
Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Departments of Physical Medicine & Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
出版信息
Reg Anesth Pain Med. 2022 Feb;47(2):89-99. doi: 10.1136/rapm-2021-103247. Epub 2021 Dec 8.
BACKGROUND
There has been a worldwide surge in interventional procedures for low back pain (LBP), with studies yielding mixed results. These data support the need for identifying outcome predictors based on unique characteristics in a pragmatic setting.
METHODS
We prospectively evaluated the association between over two dozen demographic, clinical and technical factors on treatment outcomes for three procedures: epidural steroid injections (ESIs) for sciatica, and sacroiliac joint (SIJ) injections and facet interventions for axial LBP. The primary outcome was change in patient-reported average pain intensity on a numerical rating scale (average NRS-PI) using linear regression. For SIJ injections and facet radiofrequency ablation, this was average LBP score at 1 and 3 months postprocedure, respectively. For ESI, it was average leg pain 1- month postinjection. Secondary outcomes included a binary indicator of treatment response (success).
RESULTS
346 patients were enrolled at seven hospitals. All groups experienced a decrease in average NRS-PI (p<0.0001; mean 1.8±2.6). There were no differences in change in average NRS-PI among procedural groups (p=0.50). Lower baseline pain score (adjusted coefficient -0.32, 95% CI -0.48 to -0.16, p<0.0001), depressive symptomatology (adjusted coefficient 0.076, 95% CI 0.039 to 0.113, p<0.0001) and obesity (adjusted coefficient 0.62, 95% CI 0.038 to 1.21, p=0.037) were associated with smaller pain reductions. For procedural outcome, depression (adjusted OR 0.94, 95% CI 0.91, 0.97, p<0.0001) and poorer baseline function (adjusted OR 0.59, 95% CI 0.36, 0.96, p=0.034) were associated with failure. Smoking, sleep dysfunction and non-organic signs were associated with negative outcomes in univariate but not multivariate analyses.
CONCLUSIONS
Identifying treatment responders is a critical endeavor for the viability of procedures in LBP. Patients with greater disease burden, depression and obesity are more likely to fail interventions. Steps to address these should be considered before or concurrent with procedures as considerations dictate.
TRIAL REGISTRATION NUMBER
NCT02329951.
背景
世界各地对腰痛（LBP）的介入治疗呈上升趋势，研究结果喜忧参半。这些数据支持根据实际情况，基于独特的特征确定结果预测因子的需求。
方法
我们前瞻性地评估了 20 多项人口统计学、临床和技术因素与三种治疗方法的治疗结果之间的关系：硬膜外类固醇注射（ESI）治疗坐骨神经痛，骶髂关节（SIJ）注射和关节突介入治疗轴向 LBP。主要结果是使用线性回归来改变患者报告的平均疼痛强度（平均 NRS-PI）。对于 SIJ 注射和关节突射频消融术，分别为术后 1 个月和 3 个月的平均 LBP 评分。对于 ESI，它是注射后 1 个月的平均腿部疼痛。次要结果包括治疗反应（成功）的二进制指标。
结果
在七家医院共纳入 346 名患者。所有组的平均 NRS-PI 均降低（p<0.0001；平均 1.8±2.6）。程序组之间平均 NRS-PI 的变化无差异（p=0.50）。基线疼痛评分较低（调整后的系数-0.32，95%CI-0.48 至-0.16，p<0.0001）、抑郁症状（调整后的系数 0.076，95%CI 0.039 至 0.113，p<0.0001）和肥胖（调整后的系数 0.62，95%CI 0.038 至 1.21，p=0.037）与疼痛减轻幅度较小相关。对于程序结果，抑郁（调整后的 OR 0.94，95%CI 0.91，0.97，p<0.0001）和基线功能较差（调整后的 OR 0.59，95%CI 0.36，0.96，p=0.034）与失败相关。在单变量分析中，吸烟、睡眠功能障碍和非器质性体征与不良结果相关，但在多变量分析中则不然。
结论
确定治疗反应者是 LBP 手术可行性的关键。疾病负担较大、抑郁和肥胖的患者更有可能无法接受干预。在手术前或同时应考虑解决这些问题的措施，具体情况具体分析。
试验注册号
NCT02329951。
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