A simple test of the body can help identify which people suffering from neck pain are most likely to get epidural injections of steroid research write.
The injections inject chemicals directly to spinal nerves to reduce nerve inflammation and decrease pain.
The painful injections are an effective solution for pain in the neck however, they can cost hundreds of dollars per session, come with risk, and can only help the minority of patients studies have shown.
A new version of the physical examination, described in Mayo Clinic Proceedings of 78 patients suffering from neck pain, may aid in determining the best way to use the treatment.
“Until this point it was the result of a coin tossing 50/50 whether an epidural steroid injection could aid any neck pain patient” claims Steven P. Cohen, Professor of anesthesiology as well as critical medical care at the Johns Hopkins University School of Medicine.
“We examined a variety of factors, and we believe we’ve figured out a simple and reliable method of providing patients with more precise and personalized information about their odds of getting better and increase their chances of a successful treatment.”
Based on the American Medical Association, neck and back discomfort are one of the conditions that account for the largest percentage of healthcare expenditures across the United States. Every year doctors administer over 10 million epidural injections to treat back and neck pain.
Injecting steroids can help reduce pressure and swelling on nerves that cause pain. However, the causes of back neck and back pain can be diverse however, not everyone will get pain relief from the injections. In the end, the procedure is now under greater scrutiny from hospital systems as well as insurance companies, which is driving a search for ways to pinpoint patients who are most likely to gain.
In the study of the moment, Cohen and collaborators adapted Waddell signs, which are a set consisting of eight physical signs named for the doctor who invented them over 50 years ago, to serve as tools to help identify patients with back pain could be due to physical issues which can be treated surgically neck pain sufferers.
The symptoms that can be spotted within a matter of minutes by a physician to look for tenderness, an overreaction to the light stimulus, weakness that is not easily explained by any physical injury or anomaly and pain that subsides in the event of distraction and pain that goes beyond the normal parts in the body. “These physical exam techniques are extremely easy to execute and simple to recognize,” says Cohen.
For back discomfort, Waddell signs are used in order to determine if back pain is not organic (not caused by an causal anatomic reason). Many clinicians previously believed that these signs were an indication of malingering or psychological reasons. However, in recent years scientists have found that these non-organic symptoms could indicate more complicated underlying reasons for back pain. Studies have demonstrated that back pain sufferers with more Waddell symptoms tend to not receive treatment.
In the latest study, a team of clinicians assessed the necks of 78 patients for the eight physical signs that are not organic prior to treating them with epidural injections of steroid. In total 29 percent (23) of patients had no signs that were not organic while 21 percent (16) showed one non-organic symptom; and 50 percent (39) percent of the patients showed at least two signs prior to the injections.
A month after those whose pain nevertheless reduced by the epidural steroid injection showed an average of 1.3 non-organic symptoms, whereas patients whose pain had not diminished at the one month mark , had in average, 3.4 non-organic symptoms.
A few of the Waddell indicators were closely associated with the lack of response to injections. For instance 55% of those who did not respond to injections had apparent reactions to touch. However, just 11% who were helped by injections showed this indication. Researchers also discovered that those with more signs that were not organic and related to neck discomfort were more likely to experience chronic pain in different regions of the body along with fibromyalgia, and mental disorders.
Cohen believes that the existence of several non-organic indicators are identifying patients who may require other treatments prior to attempting epidural injections of steroid. “But more research should be conducted to identify the most appropriate treatment options.”
At present, Cohen says the findings will help direct conversations between neck pain sufferers and their physicians while weighing the potential advantages and risks of an epidural injection of steroid.
Coauthors include Walter Reed National Military Medical Center The District of Columbia Veterans Affairs Medical Center, Seoul National University in Korea and Johns Hopkins.
The research was funded partly through The US Department of Defense.
SourceJohns Hopkins University
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