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Association of Protein and Genetic Biomarkers With Response to Lumbar Epidural Steroid Injections in Subjects With
Stephen Schaaf1, Wan Huang, Subashan Perera
1From the Departments of Physical Medicine and Rehabilitation (SS, WH, PJ, KT, PC, SE, MC, GS), Medicine (SP, DW), and Orthopaedic Surgery (NV), University of Pittsburgh/UPMC, Pittsburgh, Pennsylvania; School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania (YC); National Institutes of Health, Bethesda, Maryland (IB); Shirley Ryan AbilityLab, Northwestern Feinberg School of Medicine, Chicago, Illinois (PJ); and Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts (JK).
Objective:
The purpose of this observational study was to examine the association of protein and genetic biomarkers with pain and pain-related disability in individuals with axial low back pain undergoing epidural steroid injections.
Design:
Forty-eight adults with axial low back pain undergoing an epidural steroid injection were recruited from an academic medical center. Blood samples were assayed at baseline and follow-up for plasma proteins and functional single-nucleotide polymorphisms associated with pain. Data regarding pain and function were collected at baseline and follow-up. The characteristics of responders (defined as 50% improvement in pain score) and nonresponders were compared, and the association between response and baseline biomarkers was examined.
Results:
Thirty-five percent of subjects were responders to injection. Responders had lower baseline plasma levels of chondroitin sulfate 846 and higher neuropeptide Y and serotonin levels than nonresponders, and baseline neuropeptide Y level correlated with change in disability levels. In addition, subjects with the variant allele for the catechol-O-methyltransferase single-nucleotide polymorphism demonstrated increased odds of responding to the injection.
Conclusions:
These data identify candidates who may have utility for patient selection for spinal procedures and provide support for exploration in prospective studies to assess and validate their predictive ability.
