Factors associated with failure of lumbar epidural steroids

The purpose of this study was to investigate factors that may influence the outcome of epidural steroid treatment for low back pain. Although the correlation of multiple factors with treatment outcome has been demonstrated, no previous studies have assessed the magnitude of risk of treatment failure associated with these factors.

Thirty-three factors derived from patient evaluation and physical examination were selected according to previous studies, clinical importance, and ease of assessment in a typical clinic setting. Two hundred nine patients were included in the analysis. Factors were analyzed by univariate and logistic regression analyses both for independent association with treatment outcome and for magnitude of risk of failure associated with each factor after adjustment for other factors.

An increased risk of treatment failure was associated in univariate analysis with lower levels of education, smoking, lack of employment at start of treatment, constant pain, sleep disruption, nonradicular diagnosis, prolonged duration of pain, change in recreational activities, or extreme values on psychologic scales. Alcohol use was associated with decreased risk of treatment failure. With logistic regression analysis, only prolonged duration, nonradicular diagnosis, lack of employment, and smoking were independently associated with treatment outcome.

These results suggest that several factors should be considered in treating patients with low back pain with epidural steroids. This study supports the belief that pain is a multidimensional problem and that a variety of factors may influence treatment outcome.