Prognostic value of hypersensitivity reactions on epidural steroid injection outcomes: a phenotypic signature? A prospective cohort study

Steven Cohen, Tina Doshi, Timothy Dawson, Anita Gupta, Shravani Durbhakula, Octav C. Constantinescu, Michael Jacobs, Aubrey V. Verdun, Mariam Salisu, Scott R. Griffith, Connie Kurihara

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Studies have found that diffuse pain, indicative of central sensitization, portends poor interventional outcomes. Multiple chemical sensitivities are associated with signs of central sensitization. We sought to prospectively determine whether hypersensitivity reactions (HR) were associated with epidural steroid injection (ESI) outcomes. METHODS: HR were classified as immune-related or non-immune-related and categorized by number (0=low, 1 or 2=intermediate, ≥3=high). The primary outcome measure was mean reduction in average leg pain score 1 month post-procedure. A positive outcome was defined as a two-point or greater decrease in average leg pain accompanied by satisfaction 1 month post-procedure. RESULTS: The mean number of immune-mediated and non-immune-mediated HR were 0.6±1.2 and 0.8±1.4, respectively. Individuals in the high (n=24) total HR group had a mean reduction in average leg pain of 0.1±2.7, compared with those in the low (n=61; 1.8±2.1, p=0.025) and intermediate groups (n=52; 1.6±3.1, p=0.060). For back pain and categorical successful outcome, those with fewer HR experienced greater benefit. There were no differences in outcomes when patients were stratified by immune-related HR. Among participants in the low, intermediate and high non-immune-mediated HR groups, the mean reductions in average leg pain scores were 1.7±2.5, 1.6±3.0, and -0.2±2.3, respectively (p = 0.002). 51%, 35%, and 12% of people with low, intermediate and high numbers of non-immune-mediated HR experienced a positive categorical outcome, respectively (p=0.007). CONCLUSIONS: Non-immune-related HR were inversely correlated with some ESI outcome measures.

Original languageEnglish (US)
Pages (from-to)586-594
Number of pages9
JournalRegional anesthesia and pain medicine
Volume44
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Epidural Injections
Hypersensitivity
Cohort Studies
Steroids
Prospective Studies
Leg
Pain
Central Nervous System Sensitization
Multiple Chemical Sensitivity
Outcome Assessment (Health Care)
Back Pain

Keywords

  • chronic pain: back pain
  • chronic pain: central pain syndromes, fibromyalgia
  • interventional pain management
  • neuraxial blocks: epidural
  • spinal/epidural injection

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Prognostic value of hypersensitivity reactions on epidural steroid injection outcomes : a phenotypic signature? A prospective cohort study. / Cohen, Steven; Doshi, Tina; Dawson, Timothy; Gupta, Anita; Durbhakula, Shravani; Constantinescu, Octav C.; Jacobs, Michael; Verdun, Aubrey V.; Salisu, Mariam; Griffith, Scott R.; Kurihara, Connie.

In: Regional anesthesia and pain medicine, Vol. 44, No. 5, 01.05.2019, p. 586-594.

Research output: Contribution to journalArticle

Cohen, Steven ; Doshi, Tina ; Dawson, Timothy ; Gupta, Anita ; Durbhakula, Shravani ; Constantinescu, Octav C. ; Jacobs, Michael ; Verdun, Aubrey V. ; Salisu, Mariam ; Griffith, Scott R. ; Kurihara, Connie. / Prognostic value of hypersensitivity reactions on epidural steroid injection outcomes : a phenotypic signature? A prospective cohort study. In: Regional anesthesia and pain medicine. 2019 ; Vol. 44, No. 5. pp. 586-594.
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AU - Durbhakula, Shravani

AU - Constantinescu, Octav C.

AU - Jacobs, Michael

AU - Verdun, Aubrey V.

AU - Salisu, Mariam

AU - Griffith, Scott R.

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AB - BACKGROUND: Studies have found that diffuse pain, indicative of central sensitization, portends poor interventional outcomes. Multiple chemical sensitivities are associated with signs of central sensitization. We sought to prospectively determine whether hypersensitivity reactions (HR) were associated with epidural steroid injection (ESI) outcomes. METHODS: HR were classified as immune-related or non-immune-related and categorized by number (0=low, 1 or 2=intermediate, ≥3=high). The primary outcome measure was mean reduction in average leg pain score 1 month post-procedure. A positive outcome was defined as a two-point or greater decrease in average leg pain accompanied by satisfaction 1 month post-procedure. RESULTS: The mean number of immune-mediated and non-immune-mediated HR were 0.6±1.2 and 0.8±1.4, respectively. Individuals in the high (n=24) total HR group had a mean reduction in average leg pain of 0.1±2.7, compared with those in the low (n=61; 1.8±2.1, p=0.025) and intermediate groups (n=52; 1.6±3.1, p=0.060). For back pain and categorical successful outcome, those with fewer HR experienced greater benefit. There were no differences in outcomes when patients were stratified by immune-related HR. Among participants in the low, intermediate and high non-immune-mediated HR groups, the mean reductions in average leg pain scores were 1.7±2.5, 1.6±3.0, and -0.2±2.3, respectively (p = 0.002). 51%, 35%, and 12% of people with low, intermediate and high numbers of non-immune-mediated HR experienced a positive categorical outcome, respectively (p=0.007). CONCLUSIONS: Non-immune-related HR were inversely correlated with some ESI outcome measures.

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