Article

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
(R(2)=16.8%) and leg pain (R(2)=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 (beta=.87, P<.01) and pain
interference (beta=.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.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS