Smuek Asher, Bakshi Rishi, Mays Romeo, Huynh Lisa, Levin Joshua, Rittenberg Joshua, Smuck Matthew
Division of PM&R, Department of Orthopaedic Surgery, Stanford University, 450 Broadway St., Redwood City, CA, USA.
Department of PM&R, University of Michigan, Ann Arbor, MI, USA.
Interv Pain Med. 2025 Aug 20;4(3):100632. doi: 10.1016/j.inpm.2025.100632. eCollection 2025 Sep.
"Is this injection going to hurt?" Physicians typically answer this from experience since accurate answers are not available in the literature.
To quantify pain during common lumbosacral spine injections and compare to baseline pain prior to the injections. Analyze differences based on demographic and procedure variables.
This is a secondary analysis of prospectively collected data from a multicenter trial of patients undergoing bilateral symmetric transforaminal epidural (TFE), facet joint (FJ), or sacroiliac joint (SIJ) injections. Numeric pain ratings (0-10) were obtained at baseline in preop ("What is your current pain?") and for each injection procedure ("How much did this injection hurt from start to finish?") first on the right side then the left. Between group comparisons used Chi-squared and ANOVA for categorical and continuous variables, respectively. T-tests compared various pain responses, and multivariate regression determined factors associated with higher procedure pain.
From 244 injections (124 TFE, 60 FJ, 60 SIJ) on 122 consecutive patients (mean age 57.2, 50 % female), age and BMI did not differ between injection groups while sex did (p = 0.001) with more FJ males and SIJ females. Mean baseline pain was statistically equivalent between demographic and injection groups. Mean procedure pain was consistently higher than mean baseline pain, however this difference was small and non-significant for TFE (4.0 vs 3.8) and FJ (3.9 vs 3.3), but larger and significant for SIJ (5.3 vs. 3.6; p = 0.0001). In the multivariate regression analysis only 2 variables remained associated with higher procedure pain, older age (p < 0.0001) and SIJ injection group (p = 0.0021).
The majority of patients (79.1 %) report mild or moderate pain during common lumbosacral spine injections. The average procedure pain of 4.3 on the NPRS scale was only 0.7 points higher than baseline pain recorded in pre-op. Procedure pain from TFE and FJ injections is statistically equivalent to baseline pain and to each other, while SIJ injections produce higher procedure pain with a significant +1.7 point mean increase in pain from baseline. Finally, older adults report significantly greater procedure pain compared to those under 65 years old.
“这次注射会疼吗？”医生通常根据经验回答这个问题，因为文献中没有准确的答案。
量化常见腰骶部脊柱注射时的疼痛程度，并与注射前的基线疼痛进行比较。根据人口统计学和操作变量分析差异。
这是一项对前瞻性收集的数据进行的二次分析，这些数据来自一项多中心试验，该试验的患者接受双侧对称经椎间孔硬膜外注射（TFE）、小关节（FJ）或骶髂关节（SIJ）注射。在术前基线时（“你目前的疼痛程度如何？”）以及每次注射操作时（“从开始到结束，这次注射有多疼？”）获取数字疼痛评分（0 - 10），先右侧后左侧。组间比较分别使用卡方检验和方差分析来分析分类变量和连续变量。t检验比较各种疼痛反应，多变量回归确定与较高操作疼痛相关的因素。
对122例连续患者（平均年龄57.2岁，50%为女性）进行了244次注射（124次TFE、60次FJ、60次SIJ），各注射组之间年龄和体重指数无差异，但性别有差异（p = 0.001），FJ组男性更多，SIJ组女性更多。各人口统计学组和注射组之间的平均基线疼痛在统计学上相当。平均操作疼痛始终高于平均基线疼痛，然而，TFE组（4.0对3.8）和FJ组（3.9对3.3）的这种差异较小且无统计学意义，但SIJ组的差异较大且有统计学意义（5.3对3.6；p = 0.0001）。在多变量回归分析中，只有两个变量与较高的操作疼痛相关，即年龄较大（p < 0.0001）和SIJ注射组（p = 0.0021）。
大多数患者（79.1%）在常见腰骶部脊柱注射期间报告有轻度或中度疼痛。NPRS量表上的平均操作疼痛为4.3，仅比术前记录的基线疼痛高0.7分。TFE和FJ注射的操作疼痛在统计学上与基线疼痛相当，且二者之间也相当，而SIJ注射产生的操作疼痛更高，与基线相比平均疼痛显著增加1.7分。最后，与65岁以下的成年人相比，老年人报告的操作疼痛明显更严重。
