Time to Epidural Steroid Injection and Complete Remission in Zoster-Associated Pain: A Multicenter Retrospective...

Area of Science:

• Pain Management
• Neurology
• Dermatology

Background:

• Zoster-associated pain (ZAP) management benefits from early epidural steroid injection (ESI), but optimal timing is not well-defined.
• Previous research on ZAP treatment timing primarily focused on pain reduction metrics.

Purpose of the Study:

• To investigate the impact of epidural steroid injection timing on treatment outcomes in patients with zoster-associated pain.
• To evaluate complete remission and successful response rates based on ESI initiation within or after 30 days.

Main Methods:

• A multicenter retrospective cohort study included 215 patients with ZAP undergoing a three-session ESI course.
• Patients were categorized into early (<30 days) and delayed (≥30-≤180 days) treatment groups.
• Primary endpoint: complete remission (≥50% VAS reduction, VAS ≤ 2, sensory normalization) at 12 weeks. Secondary endpoint: successful response (≥50% VAS reduction).

Main Results:

• Complete remission rates were 82.1% in the early group versus 39.0% in the delayed group.
• Successful response rates were 91.7% in the early group versus 67.8% in the delayed group.
• Each day of delay in ESI initiation decreased the odds of complete remission (aOR, 0.957) and increased the odds of a worse outcome category (aOR, 1.030).

Conclusions:

• Earlier initiation of epidural steroid injections for zoster-associated pain is linked to higher rates of complete remission.
• Treatment timing is clinically significant, and recovery assessment should include pain reduction, residual pain intensity, and sensory normalization.