Abstract
This study evaluates the effect of paravertebral spinal injection (PSI), utilizing both subjective and objective assessments in chronic low back pain (LBP) associated with facet joint arthrosis over a one-month duration. Subjective questionnaires included the visual analogue scale (VAS) for pain, the Oswestry Disability Index, the Health Survey SF-12, and the short Falls Efficacy Scale International (FES-I). Objective assessments included in-clinic gait and Timed Up and Go (TUG) tests using wearable sensors, as well as 48 h daily physical activity (DPA) monitored using a chest-worn triaxial accelerometer. Subjective and objective measures were performed prior to treatment, immediately after the treatment, and one month after the treatment. Eight LBP patients were recruited for this study (mean age = 54 ± 13 years, body mass index = 31.41 ± 6.52 kg/m2, 50% males). Results show significant decrease in pain (~55%, p < 0.05) and disability (Oswestry scores, ~21%, p < 0.05). In-clinic gait and TUG were also significantly improved (~16% and ~18% faster walking and shorter TUG, p < 0.05); however, DPA, including the percentage of physical activities (walking and standing) and the number of steps, showed no significant change after PSI (p > 0.25; effect size ≤ 0.44). We hypothesize that DPA may continue to be truncated to an extent by conditioned fear-avoidance, a psychological state that may prevent increase in daily physical activity to avoid pain.
Highlights
Low back pain (LBP) is the second most common source of disability in the United States, affecting more than 80% of the population during their lifetime [1,2]
We investigated how the effect of spinal injection, a common minimally-invasive pain reduction intervention, can reduce low back pain (LBP) symptoms and pain caused by lumbar facet joint arthrosis, and how these effects may enhance daily physical activity (DPA)
One study assessed pain, disability, and physical impairment one week post-injection for lumbar spinal stenosis, but found that improvements in pain and function compared to baseline measurements did not positively correlate with the objective assessment of total activity over a period of seven days; no significant changes in physical performance were discovered with treatment using fluoroscopically guided epidural steroid injections [12]
Summary
Low back pain (LBP) is the second most common source of disability in the United States, affecting more than 80% of the population during their lifetime [1,2]. One study investigated transforaminal or caudal fluroscopically guided epidural steroid injections for lumbar spinal stenosis, which found that 32% of the patients reported pain relief beyond two months post-injection, along with 53% who confirmed functional ability improvement at an average of 1.5 years post-injection [9]. Functional disability measured by the Roland-Morris Disability Questionnaire was insignificantly improved after six weeks of fluoroscopically guided transforaminal or interlaminar epidural steroid injections for lumbar spinal stenosis compared to baseline [11]. One study assessed pain, disability, and physical impairment one week post-injection for lumbar spinal stenosis, but found that improvements in pain and function compared to baseline measurements did not positively correlate with the objective assessment of total activity over a period of seven days; no significant changes in physical performance were discovered with treatment using fluoroscopically guided epidural steroid injections [12]. We investigated: (1) how objectively measured DPA would change over the one-month period following spinal injection treatment; and (2) if and how much DPA measurement would be associated with post-treatment alterations in pain, disability, and objective in-clinic measures of gait and Timed Up and Go (TUG)
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