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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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