The effectiveness of transforaminal epidural steroid injection in patients with radicular low back pain: Combination of pain provocation with effectiveness results.

Abstract

This study aims to investigate the efficacy of transforaminal epidural steroid injection (TFESI) on low back pain relief and functional impairments and whether pain provocation during injection has an effect on pain relief in mid-term. The study, which was conducted between September 2012 and September 2013, included 62 patients with low back pain (38 males, 24 females; median age 45 years; min 22 - max 88 years). All injections were applied under C-arm fluoroscopy guidance, using a mix of betamethasone and lidocaine. A 100 mm Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), and Short Form-36 were administered before the injection, and at post-injection second and 12th weeks. Presence of any pain provocation was questioned during injection. The most frequent level of intervention was L5 level. Median initial VAS score was 80.0 (50.0;100.0) mm, which was measured as 45.0 (0.0;90.0) mm and 30.0 (0.0;100.0) mm at the post-injection second and 12th weeks, respectively. Median initial ODI score was 25.0 (9.0;43.0) points, which was measured as 17.0 (3.0;38.0) and 12.5 (1.0;38.0) points at the post-injection second and 12th weeks, respectively. All subgroup scores of SF-36 improved significantly during the follow-up period. We detected statistically significant improvements in the outcome measurements at the post-injection second and 12th weeks (p<0.05). There were significant differences between patients with positive and moderate pain provocation in terms of VAS (p=0.004) and ODI (p=0.006) scores. In this follow-up study, transforaminal epidural steroid injection was found to be effective in both the early period and in the mid-term. Pain provocation was not clinically predictive for better outcome according to the results.