Presented at the 2012 AAPM Annual Meeting « Back

The Association Between Maintenance TFESI for Lower Limb Radicular Pain and Duration of Symptoms—A Retrospective Study in a Large Academic Pain Center

Wenchun Qu, MD PhD, qu.wenchun@mayo.edu¹, Timothy P. Maus, MD¹, Naveen S. Murthy, MD¹, (1) Mayo Clinic, Rochester, Minnesota

Introduction: Repeated Transforaminal Epidural Steroid Injection (TFESI) have been used for effective maintenance management of lower limb radicular pain. It has been reported that a substantial percentage of patients receive repeat injections after an initial TFESI. There has not been a report that examines the intervals between and risk factors associated with repeat injections. Methods: All patients who received TFESI from 2006 to 2010 were reviewed. Patients’ duration of symptoms were collected before the first injection. Intervals between injections in each patient were recorded. Proportion of patients in each pain duration group by repeat intervals was reported; chi-square was used to determine the statistical significance. Results: A total of 2957 patients with lumbosacral radicular pain received 4605 TFESIs. For management of the same pain, 1168 (39.5%) received subsequent TFESIs, of which 281 patients suffered pain for less than 3 months, 172 suffered 3 to 6 months, 116 suffered 6 to 12 months, and 524 suffered >1 year. Duration of pain before first injection was statistically significantly associated with the shorter intervals between injections (Chisq = 43.2 with df = 12, p<0.001). The proportion of patients receiving repeat injections with intervals of less than 3 months was highest in the group with <3 months’ duration of pain (n = 198, 70%), subsequently followed by the group with 3–6 months duration (n = 112, 66%) and 6–12 months duration (n = 72, 62%), and it was lowest with the group with more than one year (n = 261, 50%). Conclusion: Shorter duration of preinjection pain was statistically significantly associated with shorter intervals between repeat injections. References: 1)L. Ng, N. Chaudhary and P. Sell, The efficacy of corticosteroids in periradicular infiltration for chronic radicular pain: a randomized, double-blind, controlled trial. Spine, 30 (2005), pp. 857–862. 2)J. Wilson-MacDonald, G. Burt, D. Griffin and C. Glynn, Epidural steroid injection for nerve root compression. J Bone Joint Surg Br, 87 (2005), pp. 352–355. 3)The Basis for Recommending Repeated Epidural Steroid Injections for Radicular Low Back Pain: A Literature Review Novak Arch Phys Med Rehab 2008

Funding: None