Bowman S J, Wedderburn L, Whaley A, Grahame R, Newman S
Rheumatology Department, Guy's Hospital, London.
Spine (Phila Pa 1976). 1993 Aug;18(10):1345-50. doi: 10.1097/00007632-199308000-00014.
Epidural corticosteroid injection is a relatively effective treatment for low back pain and sciatica with a low incidence of side effects, although the patient's perspective in terms of outcome and satisfaction has not been studied well. The assessment of outcome in low back pain patients is complex. Three types of measure were compared: 1) a clinical score, 2) patient ratings of pain and disability, and 3) patient satisfaction ratings. There were significant discrepancies among the results. Consequently, clinical trials using different outcome measures may reach different conclusions. It therefore is vital to have planned the study carefully in advance, considering the questions to be asked, especially in this area, where patient-derived measures (e.g., "patient satisfaction") are so important. This study of 35 patients showed a fall in clinical signs/symptoms, disability, and pain 1 week after the injection, with maintenance of the reduction in disability at 3 months. Eighty-five percent reported at least some improvement at 1 week and 43% had improvement lasting 3 months. Patients with a more depressed mood had higher levels of disability both before and after the procedure. Anxiety before the procedure did not adversely affect outcome, and it was well tolerated by most patients. At 3 months 83% were satisfied with the treatment they had received and a patient satisfaction questionnaire gave similar results. We continue to recommend this treatment as a well-tolerated procedure, with which most patients are satisfied.
硬膜外皮质类固醇注射是治疗腰痛和坐骨神经痛的一种相对有效的方法，副作用发生率较低，不过患者对治疗结果和满意度的看法尚未得到充分研究。评估腰痛患者的治疗结果很复杂。比较了三种测量方法：1）临床评分，2）患者对疼痛和残疾的评分，3）患者满意度评分。结果之间存在显著差异。因此，使用不同结果测量方法的临床试验可能会得出不同的结论。因此，提前仔细规划研究至关重要，要考虑提出的问题，尤其是在这个患者衍生测量方法（如“患者满意度”）非常重要的领域。这项对35名患者的研究表明，注射后1周临床体征/症状、残疾和疼痛有所减轻，3个月时残疾程度持续降低。85%的患者在1周时报告至少有一些改善，43%的患者改善持续3个月。情绪较为低落的患者在手术前后的残疾程度较高。术前焦虑对治疗结果没有不利影响，大多数患者对其耐受性良好。3个月时，83%的患者对所接受的治疗感到满意，一份患者满意度调查问卷也得出了类似结果。我们继续推荐这种耐受性良好的治疗方法，大多数患者对其感到满意。
