Rajput Kanishka, Howie Benjamin A, Danesh Julius Araash, Zhao Xiwen, Lin Hung-Mo, Yanez David, Chow Robert
Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Reg Anesth Pain Med. 2025 Jun 10;50(6):489-494. doi: 10.1136/rapm-2023-105247.
Catastrophizing is associated with worse pain outcomes after various procedures suggesting its utility in predicting response. However, the stability of pain catastrophizing as a static predictor has been challenged. We assess, among patients undergoing steroid injections for chronic low back pain (cLBP), whether catastrophizing changes with the clinical response to pain interventions.
This prospective study enrolled patients undergoing fluoroscopic-guided injections for cLBP. Patients filled out Brief Pain Inventory (BPI) and Pain Catastrophizing Scale (PCS) at baseline and 1-month follow-up. We assessed the change in PCS scores from pre-injection to post-injection and examined its predictors. We also examined the correlation of various domains of BPI, such as pain severity and effect on Relationships, Enjoyment, and Mood (REM), with PCS scores at baseline and follow-up.
128 patients were enrolled. Mean (SD) PCS and pain severity scores at baseline were 22.38 (±13.58) and 5.56 (±1.82), respectively. Follow-up PCS and pain severity scores were 19.76 (±15.25) and 4.42 (±2.38), respectively. The change in PCS pre-injection to post-injection was not significant (p=0.12). Multiple regression models revealed baseline PCS and REM domain of BPI as the most important predictors of change in PCS after injection. Pain severity, activity-related pain, age, sex, insurance status, depression, prior surgery, opioid use, or prior interventions did not predict change in PCS score. In correlation analysis, change in PCS was moderately correlated with change in pain (r=0.38), but weakly correlated with baseline pain in all pain domains.
PCS showed non-significant improvement following steroid injections; the study was not powered for this outcome. Follow-up PCS scores were predicted by the REM domain of BPI, rather than pain severity. Larger studies are needed to evaluate a statistically significant and clinically meaningful change in catastrophizing scores following pain interventions.
灾难化思维与各种治疗后的疼痛不良结局相关，提示其在预测反应方面的作用。然而，疼痛灾难化作为一种静态预测指标的稳定性受到了挑战。我们在接受类固醇注射治疗慢性下腰痛（cLBP）的患者中评估，疼痛灾难化是否会随着对疼痛干预的临床反应而变化。
这项前瞻性研究纳入了接受荧光镜引导下注射治疗cLBP的患者。患者在基线和1个月随访时填写简短疼痛问卷（BPI）和疼痛灾难化量表（PCS）。我们评估了PCS评分从注射前到注射后的变化，并检查了其预测因素。我们还检查了BPI的各个领域，如疼痛严重程度以及对人际关系、享受和情绪（REM）的影响，与基线和随访时的PCS评分之间的相关性。
共纳入128例患者。基线时PCS和疼痛严重程度评分的平均值（标准差）分别为22.38（±13.58）和5.56（±1.82）。随访时PCS和疼痛严重程度评分分别为l9.76（±15.25）和4.42（±2.38）。注射前到注射后PCS的变化不显著（p=0.12）。多元回归模型显示，基线时的PCS和BPI的REM领域是注射后PCS变化的最重要预测因素。疼痛严重程度、与活动相关的疼痛、年龄、性别、保险状况、抑郁、既往手术、阿片类药物使用或既往干预均不能预测PCS评分的变化。在相关性分析中，PCS的变化与疼痛变化中度相关（r=0.38），但与所有疼痛领域的基线疼痛弱相关。
类固醇注射后PCS改善不显著；该研究未针对此结果进行足够的效能分析。随访时的PCS评分由BPI的REM领域预测，而非疼痛严重程度。需要更大规模的研究来评估疼痛干预后灾难化评分在统计学上显著且具有临床意义的变化。
