Kronik radiküler ağrılı hastalarda epidural steroid enjeksiyonlarının ağrı, fonksiyon ve psikolojik sonuçlar üzerine etkisi: Prospektif kohort çalışması Epidural steroid enjeksiyonlarının radiküler ağrıda etkisi

Abstract

Amaç: Lomber disk hernisine bağlı radikülopati ile birlikte bel ağrısı önemli bir sakatlık nedenidir. Konservatif tedavilerin başarısız olduğu durumlarda yaygın olarak uygulanan epidural steroid enjeksiyonlarının (ESE) sonuçları değişkendir ve ağrı felaketleştirmesi, depresyon ve anksiyete gibi psikolojik faktörlerin bu sonuçlar üzerindeki etkileri yeterince araştırılmamıştır. Bu bağlamda, bu çalışmanın amacı ESE'lerin ağrı şiddeti, fonksiyonel durum ve psikolojik parametreler üzerindeki etkilerini değerlendirmek ve zaman içinde ağrı azalması ile psikososyal sonuçlar arasındaki ilişkileri araştırmaktır. Gereç ve Yöntemler: Bu prospektif gözlemsel kohort çalışmasının örneklemi, lomber disk hernisine bağlı kronik radiküler ağrısı olan ve ESE uygulanan, üç ay boyunca takip edilen 50 hastadan oluşmaktadır. Hastaların ağrı yoğunluğu, fonksiyonel yetersizlik, psikolojik durum, ağrı felaketleştirme durumu ve yaşam kalitesi; başlangıç, birinci ay ve üçüncü ayda olmak üzere üç zaman noktasında sırasıyla numerik derecelendirme ölçeği (NRS), Oswestry disabilite indeksi (ODI), hastane anksiyete ve depresyon ölçeği (HADS), ağrı felaketleştirme ölçeği (PCS) ve kısa ağrı envanteri (BPI) ile değerlendirilmiştir. Sonuçlardaki değişiklikler non-parametrik testler kullanılarak analiz edilmiş, korelasyonlar Spearman's rho ve ısı haritası analizleri ile değerlendirilmiştir. Bulgular: ESE'ler tüm parametrelerde anlamlı iyileşmelere yol açmıştır. Hastaların medyan NRS skoru başlangıçta 8,0'den ESE sonrası birinci ve üçüncü ayda 2,0'ye düşmüştür (p<0,001). Benzer şekilde, hastaların medyan PCS, ODI, HADS ve BPI skorları çalışma süresi boyunca anlamlı olarak iyileşmiştir (tümü için p<0,001). Korelasyon analizi, NRS ve ODI skorları arasında güçlü pozitif korelasyonlar (birinci ayda r=0,839 ve üçüncü ayda r=0,746, her ikisi için p<0,001) ve üçüncü ayda NRS ile PCS ve HADS skorları arasında orta düzeyde korelasyonlar ortaya koymuştur. Sonuç: ESE'ler hastaların ağrısını anlamlı olarak azaltmış, fonksiyonellik ve psikolojik iyilik hallerini iyileştirmiştir. Ağrı ve psikolojik parametreler arasındaki korelasyonlar, kronik radiküler ağrılı hastalarda fiziksel ve psikososyal iyileşmenin birbiriyle bağlantılı doğasını vurgulamaktadır.

Keywords

• bel ağrısı
• radikülopati
• enjeksiyonlar
• epidural
• steroidler
• felaketleştirme
• tedavi sonucu

Ethical Statement

Ethical approval was obtained from the Pamukkale University Non-Interventional Clinical Research Ethics Committee (Approval Date: 10 September 2024; Protocol Number: E-60116787-020-579328).

The impact of epidural steroid injections on pain, function, and psychological outcomes in patients with chronic radicular pain: a prospective cohort study Epidural steroids in radicular pain

Abstract

Aim: Low back pain with radiculopathy due to lumbar disc herniation is a major cause of disability. The outcomes of epidural steroid injections (ESIs), which are commonly performed when conservative therapies fail, are variable, and the effects of psychological factors, including pain catastrophizing, depression, and anxiety, on these outcomes remain underexplored. In this context, the objective of this study is to evaluate the effects of ESIs on pain severity, functional status, and psychological parameters, and to investigate the correlations between pain reduction and psychosocial outcomes over time. Material and Methods: The sample of this prospective observational cohort study consisted of 50 patients with chronic radicular pain due to lumbar disc herniation who underwent ESIs and were followed up for three months. Patients’ pain intensity, functional disability, psychological status, pain catastrophizing status, and quality of life were assessed at three time points, i.e., baseline, after one month, and after three months, using numeric rating scale (NRS), Oswestry disability index (ODI), hospital anxiety and depression scale (HADS), pain catastrophizing scale (PCS), and brief pain inventory (BPI), including BPI relations with others, enjoyment of life, and mood (BPI REM) and BPI walking, activity, and work (BPI WAW) subscales, respectively. Changes in outcomes were analyzed using non-parametric tests, and correlations were evaluated using Spearman’s rho and heatmap analyses. Results: ESIs led to significant improvements in all parameters. Patients’ median NRS score decreased from 8.0 at baseline to 2.0 at both one and three months after they underwent ESI (p<0.001). Similarly, patients’ median PCS, ODI, HADS, and BPI scores improved significantly over the study period (all p < 0.001). Correlation analysis revealed strong positive correlations between NRS and ODI scores (r = 0.839 at one month and r = 0.746 at three months, p < 0.001 for both cases), and moderate correlations between NRS and PCS and HADS scores at three months. Conclusion: ESIs significantly reduced patients’ pain, improved their functionality, and psychological well-being. The correlations between pain and psychological parameters highlight the interconnected nature of physical and psychosocial recovery in patients with chronic radicular pain.

Keywords

• low back pain
• radiculopathy
• injections
• epidural
• steroids
• catastrophization
• treatment outcome

Ethical Statement

Ethical approval was obtained from the Pamukkale University Non-Interventional Clinical Research Ethics Committee (Approval Date: 10 September 2024; Protocol Number: E-60116787-020-579328).

References

1. Stensland M, Sanford E, Houle TT, McGeary C, Cobos BA, Lugosi S, et al. The relationship between psychosocial factors and response to epidural steroid injection for chronic lumbosacral radicular pain: a prospective pilot study. J Pain Res 2025; 18: 1991-2002.
2. Turner JA, Comstock BA, Standaert CJ, Heagerty PJ, Jarvik JG, Deyo RA, et al. Can patient characteristics predict benefit from epidural corticosteroid injections for lumbar spinal stenosis symptoms? Spine J 2015; 15: 2319-31.
3. Shermon S, Maclean J, Shim R, Kim CH. Neuropsychiatric side effects after lumbosacral epidural steroid injections: a prospective cohort study. Pain Physician 2024; 27: 149-59.
4. Wadhwa H, Rohde M, Koltsov JCB, Cabell A, Smuck M, Hu SS, et al. Incidence and risk factors for complications following cervical epidural steroid injections. Spine J 2025; 25: 886-902.
5. Cohen SP, Doshi TL, Kurihara C, Reece D, Dolomisiewicz E, Phillips CR, et al. Multicenter study evaluating factors associated with treatment outcome for low back pain injections. Reg Anesth Pain Med 2022; 47: 89-99.
6. Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA, Sullivan SD, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med 2014; 371: 11-21.
7. Jindal R, Rudol G, Okafor B, Rambani R. Role of psychological distress screening in predicting the outcomes of epidural steroid injection in chronic low back pain. J Clin Orthop Trauma 2021; 19: 26-33.
8. Bailes AH, Navlani R, Koscumb S, Malecky A, Marroquin OC, Wasan AD, et al. Use of healthcare resources in patients with low back pain and comorbid depression or anxiety. Spine J 2021; 21: 1440-9.

9. Engel-Yeger B, Keren A, Berkovich Y, Sarfaty E, Merom L. The role of physical status versus mental status in predicting the quality of life of patients with lumbar disk herniation. Disabil Rehabil 2018; 40: 302-8.
10. Rajput K, Howie BA, Danesh JA, Zhao X, Lin HM, Yanez D, et al. Relationship of pain relief with catastrophizing following interventional pain procedures for low back pain. Reg Anesth Pain Med 2025; 50: 489-94.
11. van Rysewyk S, Lovell M, Glare P. Pain catastrophizing is associated with high-dose opioids in patients with cancer pain. Acad Med 2024; 1: 7448.
12. Campos WK, Linhares MN, Sarda J, Santos ARS, Lin K, Latini A, et al. Predictors of pain recurrence after lumbar facet joint injections. Front Neurosci 2019; 13: 958.
13. Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, et al. Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage 2011; 41: 1073-93.
14. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap 1994; 23: 129-38.
15. Dicle A, Karayurt O, Dirimese E. Validation of the Turkish version of the Brief Pain Inventory in surgery patients. Pain Manag Nurs 2009; 10: 107-13.
16. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-70.
17. Aydemir O, Guvenir T, Kuey L, Kultur S. Validity and reliability of Turkish version of Hospital Anxiety and Depression Scale. Turk Psikiyatri Derg 1997; 4: 280-7.
18. Bahar-Ozdemir Y, Sencan S, Ercalik T, Kokar S, Gunduz OH. The effect of pre-treatment depression, anxiety and somatization levels on transforaminal epidural steroid injection: a prospective observational study. Pain Physician 2020; 23: E273-80.
19. Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: development and validation. Psychol Assess 1995; 7: 524-32.
20. Süren M, Okan I, Gökbakan AM, Kaya Z, Erkorkmaz Ü, Arici S, et al. Factors associated with the Pain Catastrophizing Scale and validation in a sample of the Turkish population. Turk J Med Sci 2014; 44: 104-8.
21. Fairbank J. Use of Oswestry Disability Index (ODI). Spine 1995; 20: 1535-7.
22. Yakut E, Düger T, Öksüz Ç, Yörükan S, Üreten K, Turan D, et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine 2004; 29: 581-5.
23. Verheijen EJA, van Haagen OBHAM, Bartels EC, van der Sloot K, van den Akker-van Marle ME, et al. Prediction of transforaminal epidural injection success in sciatica (POTEISS): a protocol for the development of a multivariable prediction model for outcome after transforaminal epidural steroid injection in patients with lumbar radicular pain due to disc herniation or stenosis. BMC Neurol 2024; 24: 290.
24. Linton SJ, Shaw WS. Impact of psychological factors in the experience of pain. Phys Ther 2011; 91: 700-11.
25. Sariyildiz MA, Batmaz I, Hattapoğlu S. Predictors of successful treatment after transforaminal epidural steroid injections in patients with lumbar disc herniation. J Back Musculoskelet Rehabil 2024; 37: 327-35.
26. Knezevic NN, Paredes S, Cantillo S, Hamid A, Candido KD. Parasagittal approach of epidural steroid injection as a treatment for chronic low back pain: a systematic review and meta-analysis. Front Pain Res 2021; 2: 676730.
27. Stensland M, McGeary D, Covell C, Fitzgerald E, Mojallal M, Lugosi S, et al. The role of psychosocial factors in mediating the treatment response of epidural steroid injections for low back pain with or without lumbosacral radiculopathy: a scoping review. PLoS One 2025; 20: e0316366.
28. Kim HJ, Kwon OH, Chang BS, Lee CK, Chun HJ, Yeom JS. Change in pain catastrophizing in patients with lumbar spinal surgery. Spine J 2018; 18: 115-21.
29. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull 2007; 133: 581-624.
30. Sirbu E, Onofrei RR, Szasz S, Susan M. Predictors of disability in patients with chronic low back pain. Arch Med Sci 2020; 19: 94-100.
31. Arnow BA, Hunkeler EM, Blasey CM, Lee J, Constantino MJ, Fireman B, et al. Comorbid depression, chronic pain, and disability in primary care. Psychosom Med 2006; 68: 262-8.