Schneider Byron J, Chukwuma Valentine U, Fechtel Blake M, Kennedy David J
Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
Interv Pain Med. 2024 Sep 7;3(3):100435. doi: 10.1016/j.inpm.2024.100435. eCollection 2024 Sep.
Epidural steroid injections (ESI) are utilized for the management of radicular pain, but there are no previous published studies that detail the specific timeline of patient response to an ESI.
To describe patients' temporal response in pain relief following an ESI.
STUDY DESIGN/SETTING: Prospective in vivo study of consecutive patients at an outpatient physical medicine and rehabilitation clinic at a single academic spine center.
134 consecutive patients who received an ESI between January 2020 through June 2020.
Patients were contacted every 3 days ± 1 day for 21 days post ESI to assess pain as measured via 11-point numeric pain score and subjective percentage pain relief question.
134 consecutive patients were enrolled, with 108 (80.6 %) having follow-up data through 3 weeks post ESI. At 3 weeks, 51/108 patients (47.2 %) had reported a successful response as defined by at least 50 % reduction of their pain index. Of these 51 patients, 37 (72.5 %) reported >50 % relief on day 1, a further 11 (21.6 %) first reported >50 % relief on day 4, and the remaining 3 (5.9 %) successes first reported >50 % relief on days 13, 16, and 22. 57/108 patients (52.8 %) were non-responders, most of whom never reached the 50 % threshold at any time point. Of these non-responders, 19/57 (33.3 %) did report >50 % relief on day 1. Those patient's pain relief fell below 50 % on day 4 (12/19 patients, 63.2 %), day 7 (5/19 patients, 26.3 %), day 13 (1 patient, 5.3 %), and day 16 (1 patient, 5.3 %). A positive response or negative response at each follow up point was looked at as a predictor of a concordant three-week outcome for the population. The positive likelihood ratio at follow-up day 1, day 4, day 7, and day 10, was 2.14, 6.12, 7.97, and 40 respectively. The negative likelihood ratio at follow-up day 1, day 4, day 7, and day 10 was 0.42, 0.15, 0.16, and 0.24 respectively.
DISCUSSION/CONCLUSION: This is the first study to meticulously follow up patients every 72 h after ESI. A patient's response on day 4, either positive or negative, is predictive of their 3-week outcome. Sustained relief at day 7 or 10 further increases the likelihood of a positive 3-week outcome.
硬膜外类固醇注射（ESI）用于治疗神经根性疼痛，但此前尚无已发表的研究详细说明患者对 ESI 反应的具体时间线。
描述患者在接受 ESI 后疼痛缓解的时间反应。
研究设计/地点：在单一学术脊柱中心的门诊物理医学与康复诊所对连续患者进行的前瞻性体内研究。
2020 年 1 月至 2020 年 6 月期间连续接受 ESI 的 134 名患者。
在 ESI 后 21 天内，每 3 天±1 天联系患者，通过 11 点数字疼痛评分和主观疼痛缓解百分比问题评估疼痛情况。
连续纳入 134 名患者，其中 108 名（80.6%）在 ESI 后 3 周有随访数据。在 3 周时，51/108 名患者（47.2%）报告有成功反应，定义为疼痛指数至少降低 50%。在这 51 名患者中，37 名（72.5%）在第 1 天报告疼痛缓解>50%，另外 11 名（21.6%）在第 4 天首次报告疼痛缓解>50%，其余 3 名（5.9%）在第 13、16 和 22 天首次报告疼痛缓解>50%。57/108 名患者（52.8%）无反应，其中大多数在任何时间点都未达到 50%的阈值。在这些无反应者中，19/57（33.3%）在第 1 天确实报告疼痛缓解>50%。这些患者的疼痛缓解在第 4 天（12/19 名患者，63.2%）、第 7 天（5/19 名患者，26.3%）、第 13 天（1 名患者，5.3%）和第 16 天（1 名患者，5.3%）降至 50%以下。将每个随访点的阳性或阴性反应视为总体人群 3 周结果一致性的预测指标。随访第 1、4、7 和 10 天的阳性似然比分别为 2.14、6.12、7.97 和 40。随访第 1、4、7 和 10 天的阴性似然比分别为 0.42、0.15、0.16 和 0.24。
讨论/结论：这是第一项在 ESI 后每 72 小时对患者进行细致随访的研究。患者在第 4 天的反应，无论是阳性还是阴性，都可预测其 3 周的结果。在第 7 天或第 10 天持续缓解进一步增加了 3 周结果为阳性的可能性。
