Stensland Meredith, McGeary Donald, Covell Caleigh, Fitzgerald Elizabeth, Mojallal Mahsa, Lugosi Selena, Lehman Luke, McCormick Zachary, Nabity Paul
Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States of America.
South Texas Veterans Health Care System, San Antonio, TX, United States of America.
PLoS One. 2025 Jan 15;20(1):e0316366. doi: 10.1371/journal.pone.0316366. eCollection 2025.
Epidural steroid injections (ESIs) are often used to treat low back pain (LBP) due to lumbosacral radiculopathy as well as LBP without a clear component of radiculopathy, in some cases. While it is increasingly recognized that psychosocial factors are associated with pain outcomes, few studies have assessed the contribution of these factors to common pain interventions like ESIs. This study aimed to summarize the scope and nature of how psychosocial factors are accounted for in research on ESIs for the treatment of LBP with or without lumbosacral radiculopathy and to identify gaps and recommendations for future research. A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review Extension framework was conducted. Publications dated before September 2023 were searched in PubMed, CINAHL, Scopus, PsycINFO, and Google Scholar. Of the 544 records identified through database searching, a total of 51 studies cumulatively totaling 10,447 participants were included. Sample sizes ranged from 12 to 5,104 participants. Of the 51 included studies, only 10 (20%) analyzed and reported the relationship between at least one psychosocial variable and post-injection pain at any follow-up timepoint. The other 41 (80%) included no analyses examining ESI response as a function of psychosocial variables. Based on the studies that included analysis by psychosocial variables, poor psychosocial functioning appears to be associated with inferior treatments outcomes following ESI for back pain with or without lumbosacral radiculopathy. Relative to the vast body of literature on ESIs for LBP and lumbosacral radiculopathy, minimal attention has been directed to the influence of psychosocial factors on ESI treatment outcomes. Future research evaluating predictors of the effect of ESI on pain relief should include development of more comprehensive models containing modifiable psychosocial variables as predictors of ESI response.
硬膜外类固醇注射（ESIs）常用于治疗因腰骶神经根病引起的腰痛（LBP），在某些情况下也用于治疗无明显神经根病成分的腰痛。虽然人们越来越认识到社会心理因素与疼痛结果相关，但很少有研究评估这些因素对诸如ESIs等常见疼痛干预措施的影响。本研究旨在总结在治疗伴有或不伴有腰骶神经根病的LBP的ESIs研究中，社会心理因素是如何被考虑的范围和性质，并确定未来研究的差距和建议。我们按照系统评价和Meta分析的首选报告项目-范围审查扩展框架进行了一项范围审查。在PubMed、CINAHL、Scopus、PsycINFO和谷歌学术搜索了2023年9月之前发表的文献。通过数据库搜索确定的544条记录中，总共纳入了51项研究，累计共有10447名参与者。样本量从12名到5104名参与者不等。在纳入的51项研究中，只有10项（20%）在任何随访时间点分析并报告了至少一个社会心理变量与注射后疼痛之间的关系。其他41项（80%）没有分析将ESI反应作为社会心理变量的函数。基于纳入社会心理变量分析的研究，社会心理功能不佳似乎与伴有或不伴有腰骶神经根病的背痛接受ESI治疗后的较差结果相关。相对于大量关于ESIs治疗LBP和腰骶神经根病的文献，社会心理因素对ESI治疗结果的影响很少受到关注。未来评估ESI对疼痛缓解效果预测因素的研究应包括开发更全面的模型，将可改变的社会心理变量作为ESI反应的预测因素。
