The Relationship Between Psychosocial Factors and Response to Epidural Steroid Injection for Chronic Lumbosacral Radicular Pain: A Prospective Pilot Study

Abstract

Purpose: Chronic lumbosacral radicular pain is a disabling condition commonly treated with epidural steroid injections (ESIs). Extant research suggests that psychosocial factors impact clinical outcomes among patients with back pain. The purpose of this study is to examine the relationship between psychosocial variables and post-injection pain intensity. Setting: Interventional pain management clinic. Methods: A prospective longitudinal cohort study with repeated within-subject measures. Assessment timepoints included a pre-injection baseline, immediately post-injection, 6 weeks, and 12 weeks, and 6 months; patients completed a battery of self-report assessments at each point. The primary outcome was pain intensity (numeric rating scale 0–10). Data were analyzed using principal component analysis and generalized linear mixed-effects modeling. Results: A total of 40 patients (age 52 ±13.05) participated in this study. Higher pre-injection pain was predictive of higher post-injection pain at all time points (p<0.001). Controlling for baseline pain and demographics, those with Negative Affect 1 standard deviation higher at baseline reported a 1.12-point mean higher pain rating at 12 weeks than those with lower Negative Affect (95% CI: 0.18–2.07; p=0.020), while those with Cognitive Resilience 1 standard deviation higher at baseline had a 1.12-point mean lower pain rating at 6 months post-injection (95% CI: −2.09 −0.05, p=0.040). Conclusion: Patients with higher negative affect and lower cognitive resilience achieve less pain improvement after ESIs for low back pain. Future research with a larger sample should focus on deepening our understanding of the role of psychosocial functioning as a potential mechanism of treatment response in patients undergoing ESI procedures. Findings point to the importance of multi-disciplinary chronic pain care.