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Conger AM, Randall DJ, Sperry BP, Kuo KT, Petersen R, Henrie AM, Kendall RW, Bisson EF, Teramoto M, Martin BI, Burnham TR, McCormick ZL. The effectiveness of cervical transforaminal epidural steroid injections for the treatment of cervical radicular pain: A prospective cohort study reporting 12-month outcomes. INTERVENTIONAL PAIN MEDICINE 2024; 3:100379. [PMID: 39239498 PMCID: PMC11373075 DOI: 10.1016/j.inpm.2023.100379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/03/2023] [Accepted: 12/09/2023] [Indexed: 09/07/2024]
Abstract
Objectives To evaluate the effectiveness of cervical transforaminal epidural steroid injection (CTFESI) for the treatment of unilateral cervical radicular pain. Design Single-group prospective cohort study. Methods Outcomes included ≥50% reductions in Numeric Rating Scale (NRS) for arm pain, ≥30% Neck Disability Index (NDI-5) improvement, health-related quality of life (EQ-5D), global improvement (PGIC), personal goal achievement (COMBI), Chronic Pain Sleep Index (CPSI), and healthcare utilization at one, three, six, and 12 months. Data analysis included descriptive statistics with the calculations of 95% confidence intervals (CIs), contingency table analysis, and multilevel logistic regression (LR) analysis, including a worst-case (WC) sensitivity analysis in which missing data were treated as treatment failure. Participants who were treated surgically were considered failures in the categorical analyses. Results 33 consecutively enrolled participants (63.6% females, 51.2 ± 12.2 years of age, BMI 28.3 ± 4.5 kg/m2) were analyzed. Success rates for ≥50% reduction in NRS for arm pain at one, three, six and 12 months were 57.6% (95% CI 40.8-72.8%), 71.9% (95% CI 54.6-84.4%), 64.5% (95% CI 46.9-78.9%), and 64.5% (95% CI 46.9-78.9%). Success rates for ≥30% improvement in NDI-5 were 60.6% (95% CI 43.7-75.3%), 68.8% (95% CI 51.4-82.0%), 61.3% (95% CI 43.8-76.3%), and 71.0% (95% CI 53.4-83.9%). In WC analysis, success rates for ≥50% arm NRS and NDI-5 were 0-4.3% lower between 1 and 12 months. PGIC scores were at least "much improved" or "very much improved," in 48.4-65.6% of participants between 1 and 12 months. 6.1%, 6.1%, and 3.0% had one, two, or three repeat injections, respectively. 18.2% of participants underwent surgery by 12 months. Participants showed significant improvements in arm NRS and NDI-5 after treatment (p < 0.05), multilevel logistic regression models showed no significant decline in improvements across the follow-up time points (p > 0.05). Conclusion Statistically significant and clinically meaningful improvements in pain and disability were observed after CTFESI for up to 12 months in individuals with unilateral cervical radicular pain.
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Affiliation(s)
- Aaron M Conger
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Dustin J Randall
- Department of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA, USA
| | - Beau P Sperry
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Keith T Kuo
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - A Michael Henrie
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Richard W Kendall
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Erica F Bisson
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Masaru Teramoto
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Brook I Martin
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Taylor R Burnham
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
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Peene L, Cohen SP, Brouwer B, James R, Wolff A, Van Boxem K, Van Zundert J. 2. Cervical radicular pain. Pain Pract 2023; 23:800-817. [PMID: 37272250 DOI: 10.1111/papr.13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Cervical radicular pain is pain perceived in the upper limb, caused by irritation or compression of a cervical spine nerve, the roots of the nerve, or both. METHODS The literature on the diagnosis and treatment of cervical radicular pain was retrieved and summarized. RESULTS The diagnosis is made by combining elements from the patient's history, physical examination, and supplementary tests. The Spurling and shoulder abduction tests are the two most common examinations used to identify cervical radicular pain. MRI without contrast, CT scanning, and in some cases plain radiography can all be appropriate imaging techniques for nontraumatic cervical radiculopathy. MRI is recommended prior to interventional treatments. Exercise with or without other treatments can be beneficial. There is scant evidence for the use of paracetamol, nonsteroidal anti-inflammatory drugs, and neuropathic pain medications such as gabapentin, pregabalin, tricyclic antidepressants, and anticonvulsants for the treatment of radicular pain. Acute and subacute cervical radicular pain may respond well to epidural corticosteroid administration, preferentially using an interlaminar approach. By contrast, for chronic cervical radicular pain, the efficacy of epidural corticosteroid administration is limited. In these patients, pulsed radiofrequency treatment adjacent to the dorsal root ganglion may be considered. CONCLUSIONS There is currently no gold standard for the diagnosis of cervical radicular pain. There is scant evidence for the use of medication. Epidural corticosteroid injection and pulsed radiofrequency adjacent to the dorsal root ganglion may be considered. [Correction added on 12 June 2023, after first online publication: The preceding sentence was corrected.].
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Affiliation(s)
- Laurens Peene
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Belgium
| | - Steven P Cohen
- Pain Medicine Division, Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, USA
| | - Brigitte Brouwer
- Department of Anesthesiology, Pain Medicine and Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rathmell James
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Leroy D. Vandam Professor of Anesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Andre Wolff
- Department of Anesthesiology, UMCG Pain Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Koen Van Boxem
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Belgium
- Department of Anesthesiology, Pain Medicine and Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Van Zundert
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Belgium
- Department of Anesthesiology, Pain Medicine and Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
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Kohan L, Pellis Z, Provenzano DA, Pearson ACS, Narouze S, Benzon HT. American Society of Regional Anesthesia and Pain Medicine contrast shortage position statement. Reg Anesth Pain Med 2022; 47:511-518. [DOI: 10.1136/rapm-2022-103830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/03/2022] [Indexed: 11/03/2022]
Abstract
The medical field has been experiencing numerous drug shortages in recent years. The most recent shortage to impact the field of interventional pain medicine is that of iodinated contrast medium. Pain physicians must adapt to these changes while maintaining quality of care. This position statement offers guidance on adapting to the shortage.
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Levin J, Chan J, Huynh L, Smuck M, Koltsov J, Kesikburun B, Wagner GE, Caragea M, Kuo K, McCormick ZL, Schneider B, Berlin E, Kennedy DJ, Kesikburun S. Thoracic transforaminal epidural steroid injection for management of thoracic spine pain: A multicenter cross-sectional study of short-term outcomes. INTERVENTIONAL PAIN MEDICINE 2022; 1:100004. [PMID: 39301446 PMCID: PMC11411569 DOI: 10.1016/j.inpm.2021.100004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/04/2021] [Accepted: 12/04/2021] [Indexed: 09/22/2024]
Abstract
Background Thoracic transforaminal epidural steroid injections (TFESIs) are procedures performed for the treatment of thoracic spine pain (TSP). The literature on these interventions is sparse. Purpose To report outcomes of thoracic TFESIs for TSP indications. Study design Multicenter, retrospective, cross-sectional cohort study. Patient sample Consecutive patients receiving thoracic TFESIs at three academic spine centers. Outcome measures The primary outcome was the proportion of patients reporting at least 50% improvement in NRS pain score at short-term follow-up (>1 week, <3 months post-injection). Methods A chart review was performed of consecutive patients who underwent a thoracic TFESI over a 4- to 10-year time period at three academic spine centers and had reported an NRS pain score at short-term follow-up. Results Overall, 19/64 patients (30% [95% CI 20-42%]) experienced ≥50% relief following the injection at a median 22 days follow-up. 42% [95% CI 31-54%] experienced at least a 2-point improvement in NRS score. There was a slight improvement in median NRS scores from pre-to post-procedure of -1 (IQR -3, 0), from 6/10 to 5/10 (p < 0.001). The success rate (≥50% pain relief) was 36% [95%CI 22-52%] in those with a disc herniation as compared to 21% [95%CI 10-40%]) in those with degenerative stenosis; however, the difference did not reach statistical significance. There was a trend towards a greater success rate in those who were employed vs. unemployed (43% [95% CI 27-61%] vs. 19% [95% CI 9-36%]). Conclusions This is the largest series reporting outcomes from thoracic TFESI to date. Overall, the observed success rate was low compared to known success rates associated with TFESI for the treatment of pain at cervical and lumbar spinal regions.
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Affiliation(s)
- Josh Levin
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St., Pavilion C; 4th Floor, MC 6342, Redwood City, CA, 94063, USA
- Department of Neurosurgery, Stanford University, USA
| | - John Chan
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St., Pavilion C; 4th Floor, MC 6342, Redwood City, CA, 94063, USA
| | - Lisa Huynh
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St., Pavilion C; 4th Floor, MC 6342, Redwood City, CA, 94063, USA
| | - Matt Smuck
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St., Pavilion C; 4th Floor, MC 6342, Redwood City, CA, 94063, USA
| | - Jayme Koltsov
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St., Pavilion C; 4th Floor, MC 6342, Redwood City, CA, 94063, USA
| | - Bilge Kesikburun
- Ankara City Hospital, Universiteler Mahallesi 1604. Cadde No: 9, Cankaya, Ankara, 06800, Turkey
| | - Graham E Wagner
- Division of Physical Medicine and Rehabilitation, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Marc Caragea
- Division of Physical Medicine and Rehabilitation, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Keith Kuo
- Division of Physical Medicine and Rehabilitation, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Byron Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, 2201 Children's Way, Suite 1318, Nashville, TN, 37212, USA
| | - Evan Berlin
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, 2201 Children's Way, Suite 1318, Nashville, TN, 37212, USA
| | - D J Kennedy
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St., Pavilion C; 4th Floor, MC 6342, Redwood City, CA, 94063, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, 2201 Children's Way, Suite 1318, Nashville, TN, 37212, USA
| | - Serdar Kesikburun
- University of Health Sciences Turkey, Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Universiteler Mahallesi, Lodumlu Yolu, 29 Ekim Sokak No:1, Cankay, Ankara, 06800, Turkey
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