Abstract
Objective
To describe whether negative affect and sleep impairment are associated with the clinical
effect of epidural steroid injections (ESIs) for low back pain.
Design
Observational study; patients were evaluated before ESI and 1 and 3 months after ESI.
Setting
Spine center and related treatment sites.
Participants
Participants (N=158) seeking treatment for low back pain with or without radiculopathy.
Intervention
ESI for low back pain with or without radiculopathy.
Main Outcome Measures
We assessed the dependent (global pain severity for back and leg pain, pain behavior,
pain interference) and independent variables (depression, sleep disturbance, and covariates
of back pain response) with the Patient-Reported Outcome Measurement Information System
(PROMIS) and legacy measures. Outcome was assessed cross-sectionally using multiple
regression and longitudinally with path analysis.
Results
After 1 month, sleep disturbance was the only predictor for the global ratings of
improvement in back pain (R2=16.8%) and leg pain (R2=11.4%). The proportions of variance explained by sleep disturbance and negative affect
for all dependent variables were greater at 3 months than 1 month. Mediation analysis
was significant for negative affect for the 3-month outcomes on PROMIS pain behavior
(β=.87, P<.01) and pain interference (β=.37, P<.01). There was no evidence of mediation by sleep disturbance for any outcome.
Conclusions
Negative affect and sleep disturbance are associated with worse outcomes after ESI.
Further research is needed to determine if treatment of negative affect and sleep
disturbance prior to or concurrently with ESI will improve outcomes.
Keywords
List of abbreviations:
CAT (computerized adaptive testing), CES-D (Center for Epidemiologic Studies-Depression), ESI (epidural steroid injection), MOS (Medical Outcomes Study), PROMIS (Patient-Reported Outcome Measurement Information System), RMDQ (Roland-Morris Disability Questionnaire)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 23, 2013
Footnotes
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated. (Yu, Friedly, Amtmann, Pilkonis).
A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit on 1 or more of the authors.
Karp has received research support in the form of medication supplies from Pfizer and Reckitt Benckiser.
Identification
Copyright
© 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
