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Psychosocial Factors Predicting Response to Epidural Steroid Injection (ESI) for Chronic Radicular Pain

Briana Cobos, MA (University of Texas Health Science Center- San Antonio, San Antonio, TX, United States); Don McGeary, PhD; Ameet Nagpal, MD, MS, MEd; Maxim Eckmann, MD; David E. Reed, II; Cindy McGeary, PhD

Meeting: AAPM&R Annual Assembly 2019

Session Information

Date: Saturday, November 16, 2019

Session Title: Spine and Pain Research Report

Session Time: 11:15am-12:45pm

Location: Research Hub - Kiosk 7

Disclosures: Briana Cobos, MA: Nothing to disclose

Objective: To identify psychosocial factors that predict an individual’s response to epidural steroid injection (ESI) for chronic radicular pain.

Design: Participants are asked to complete psychosocial measures before their ESI. They complete these measures again 6 weeks, 12 weeks, and 6 months after the injection.

Setting: UT Health San Antonio Pain Clinic

Participants: 60 subjects diagnosed with chronic radicular pain are expected to be enrolled.

Interventions: No study interventions are administered.

Main Outcome Measures: Numeric Rating Scale of Pain – Patients are asked to recall pain rating at 5 time points over the past 24 hours that will be averaged to establish a mean 24-hour pain rating. Psychosocial and pain-related questionnaires are also administered during each assessment time period (e.g., Generalized Anxiety Disorder Scale, Patient Health Questionnaire, Oswestry Disability Index, PROMIS Pain Interference Module).

Results: Analyses will be aimed at determining the contributing psychosocial, pain, and health behavior factors to successful ESI and low pain ratings at the expected completion of the study. Preliminary results and implications will be discussed during the presentation

Conclusions: Although ESIs are used to manage complex pain, there is mixed evidence about their effectiveness. Contemporary models of chronic back pain stress both physical and psychosocial factors that influence responses to pain and interventions. However, little is known about psychosocial variables that may influence ESI responsiveness. The purpose of this study is to offer the first ever assessment of which psychosocial variables and modifiable health behaviors influence response to ESIs. These findings hope to support the hypothesis that improving these variables before ESI may result in improved outcomes in post treatment follow-up. If supported with systematic differences in response to ESIs, then the next phase of this research will develop a brief psychosocial intervention designed to improve these variables in the hope of improving ESI treatment response.

Level of Evidence: Level I

To cite this abstract in AMA style:

Cobos B, McGeary D, Nagpal A, Eckmann M, Reed DE, McGeary C. Psychosocial Factors Predicting Response to Epidural Steroid Injection (ESI) for Chronic Radicular Pain [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/psychosocial-factors-predicting-response-to-epidural-steroid-injection-esi-for-chronic-radicular-pain/. Accessed May 12, 2025.
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