Multicenter study evaluating factors associated with treatment outcome for low back pain injections.
Multicenter study evaluating factors associated with treatment outcome for low back pain injections.
复制标题
DOI：
10.1136/rapm-2021-103247
复制
发表时间：
2022-02
影响因子：
5.1
通讯作者：
Pasquina, Paul F.
中科院分区：
文献类型：
--
作者：
Cohen, Steven P.;Doshi, Tina L.;Kurihara, Connie;Reece, David;Dolomisiewicz, Edward;Phillips, Christopher R.;Dawson, Timothy;Jamison, David;Young, Ryan;Pasquina, Paul F.
在全球范围内，下腰痛（LBP）的介入手术激增，研究结果喜忧参半。这些数据支持需要确定结果预测的基础上，在务实的设置独特的特点。我们前瞻性地评估了20多个人口统计学、临床和技术因素与3种手术治疗结果之间的相关性：坐骨神经痛的硬膜外类固醇注射（ESI），轴向LBP的骶髂关节（SIJ）注射和小关节干预。主要结局是使用线性回归的数字评定量表（平均NRS-PI）上患者报告的平均疼痛强度的变化。对于SIJ注射和小关节射频消融，这分别是术后1个月和3个月的平均LBP评分。对于ESI，其为注射后1个月的腿部疼痛。次要结局包括治疗反应（成功）的二元指标。346例患者在7家医院入组。所有组的平均NRS-PI均降低（p < 0.0001;平均值1.8 ± 2.6）。手术组之间的平均NRS-PI变化无差异（p = 0.50）。较低的基线疼痛评分（校正系数为-0.32，95% CI为-0.48至-0.16，p<0.0001）、抑郁性精神病（0.076，95% CI为0.039至0.113，p<0.0001）和肥胖（0.62，95% CI为0.038至1.21，p= 0.037）与较小的疼痛减轻相关。对于手术结局，抑郁（调整OR 0.94，95% CI 0.91，0.97，p<.0001）和基线功能较差（调整OR 0.59，95% CI 0.36，0.96，p=.034）与失败相关。在单变量分析中，吸烟、睡眠障碍和非器质性体征与阴性结果相关，但在多变量分析中则不然。识别治疗反应者是LBP手术可行性的关键奋进。疾病负担、抑郁和肥胖的患者更有可能无法通过干预。解决这些问题的步骤应根据需要在程序之前或同时考虑。
There has been a worldwide surge in interventional procedures for low back pain (LBP), with studies yielding mixed results. These data support the need for identifying outcome predictors based on unique characteristics in a pragmatic setting. We prospectively evaluated the association between over 2 dozen demographic, clinical and technical factors on treatment outcomes for 3 procedures: epidural steroid injections (ESI) for sciatica, and sacroiliac joint (SIJ) injections and facet interventions for axial LBP. The primary outcome was change in patient-reported average pain intensity on a numerical rating scale (average NRS-PI) using linear regression. For SIJ injections and facet radiofrequency ablation, this was average LBP score at 1- and 3-months post-procedure, respectively. For ESI, it was leg pain 1-month post-injection. Secondary outcomes included a binary indicator of treatment response (success). 346 patients were enrolled at 7 hospitals. All groups experienced a decrease in average NRS-PI (p < 0.0001; mean 1.8 ± 2.6). There were no differences in change in average NRS-PI among procedural groups (p = 0.50). Lower baseline pain score (adjusted coefficient −0.32, 95% CI −0.48to −0.16, p<0.0001), depressive symptomatology (0.076, 95% CI 0.039 to 0.113, p<0.0001) and obesity (0.62, 95% CI 0.038 to 1.21, p=.037) were associated with smaller pain reductions. For procedural outcome, depression (adjusted OR 0.94, 95% CI 0.91, 0.97, p<.0001) and poorer baseline function (adjusted OR 0.59, 95% CI 0.36, 0.96, p=.034) were associated with failure. Smoking, sleep dysfunction and non-organic signs were associated with negative outcomes in univariate, but not multivariate analyses. Identifying treatment responders is a critical endeavor for the viability of procedures in LBP. Patients with greater disease burden, depression and obesity are more likely to fail interventions. Steps to address these should be considered before or concurrent with procedures as considerations dictate.
登录
查看更多内容
影响因子：
2.9
作者：
Jakobsen, Janus Christian;Ovesen, Christian;Wetterslev, Jorn
通讯作者：
Wetterslev, Jorn
影响因子：
5.3
作者：
Friedly, Janna;Chan, Leighton;Deyo, Richard
通讯作者：
Deyo, Richard
影响因子：
7.2
作者：
Austin, Peter C.;Steyerberg, Ewout W.
通讯作者：
Steyerberg, Ewout W.
影响因子：
5.7
作者：
Cohen, Steven P.;Doshi, Tina L.;Pasquina, Paul F.
通讯作者：
Pasquina, Paul F.
影响因子：
3.1
作者：
Engle, Alyson Marie;Chen, Yian;Cohen, Steven Paul
通讯作者：
Cohen, Steven Paul