Screening Instruments for the Prediction of Long-Term Response to Epidural Steroid Injection in the Treatment of Lumbar Radiculopathy

Craig T. Hartrick, MD

Published: 2 February 1998

The objective of this study was to identify factors predicting long-term response to lumbar epidural steroid injection in the treatment of chronic lumbosacral radiculopathy using a battery of simple screening instruments. Over a 5-year period, 80 consecutively referred outpatients with lumbosacral radiculopathy of at least 4 months duration were prospectively studied. A short questionnaire including the McGill Pain Questionnaire, the Zung Anxiety Scale, the Posttraumatic Chronic Pain Test, and visual analog scales for pain and function was administered prior to treatment and at follow-up a minimum of 6 months later. Significant long-term improvement was observed in a majority of patients only when there were no workers' compensation claims, disability benefits currently being paid, or pending litigation. The average number of treatments administered was 2.6 (range 1­3), and the average time to outcome assessment was 17 months. Prolonged duration of pain prior to treatment and elevated Zung Anxiety scores predicted treatment failure in patients without litigation factors. Elevated anxiety levels were found to predict long-term failure of lumbar epidural steroids to relieve chronic radiculopathy pain.

Keywords: epidural steroid, radiculopathy, anxiety, posttraumatic chronic pain test, litigation