Thermal QST phenotypes associated with response to lumbar epidural steroid injections: A pilot study

Abstract

Objective. Response to lumbar epidural steroid injection in lumbar radicular pain varies. The purpose of this study is to characterize the changes in quantitative sensory testing (QST) phenotypes of subjects and compare the QST characteristics in patients who do respond to treatment of radicular pain with a lumbar epidural steroid injection (ESI). Design. Prospective, observational pilot study. Setting. Outpatient pain center. Methods. Twenty subjects with a lower extremity (LE) radicular pain who were scheduled to have an ESI were recruited. At the visit prior to and four weeks following an ESI, subjects underwent QST measurements of both the affected LE and the contralateral unaffected UE. Results. Following an ESI, nine subjects reported a greater than 30% reduction in radicular pain and 11 reported a less than 30% reduction in radicular pain. Subjects who had less than 30% pain reduction response (nonresponders) to an ESI had increased pre-injection warm sensation threshold (37.30 °C, SD=2.51 vs 40.39, SD=3.36, P = 0.03) and heat pain threshold (47.22 °C, SD=1.38, vs 48.83 °C, SD=2.10, P =0.04). Further, the nonresponders also showed increased preinjection warm sensation threshold as measured in the difference of warm sensation detection threshold difference in the affected limb and the unaffected arm (2.68 °C, SD=2.92 vs 5.67 °C, SD=3.22, P=0.045). Other QST parameters were not affected. Conclusions. The results show that the nonresponders to ESIs have increased detection threshold to heat pain and warm sensation, suggesting that a preexisting dysfunction in the C fibers in this group of subjects who can be detected by QST. Such altered QST characteristics may prognosticate the response to ESIs.