Relationship of pain relief with catastrophizing following interventional pain procedures for low back pain

Kanishka Rajput; Benjamin A Howie; Julius Araash Danesh; Xiwen Zhao; Hung-Mo Lin; David Yanez; Robert Chow

doi:10.1136/rapm-2023-105247

Relationship of pain relief with catastrophizing following interventional pain procedures for low back pain

Reg Anesth Pain Med. 2024 May 13:rapm-2023-105247. doi: 10.1136/rapm-2023-105247. Online ahead of print.

Authors

Kanishka Rajput¹, Benjamin A Howie^{2

3}, Julius Araash Danesh⁴, Xiwen Zhao⁵, Hung-Mo Lin⁵, David Yanez⁶, Robert Chow⁵

Affiliations

¹ Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA kanishka.rajput@yale.edu.
² Icahn School of Medicine at Mount Sinai, New York, New York, USA.
³ Yale-New Haven Hospital, New Haven, Connecticut, USA.
⁴ Department of Pain Medicine, West Virginia University-Health Sciences Campus, Morgantown, West Virginia, USA.
⁵ Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA.
⁶ Duke University, Durham, North Carolina, USA.

PMID: 38744446
DOI: 10.1136/rapm-2023-105247

Abstract

Introduction: Catastrophizing is associated with worse pain outcomes after various procedures suggesting its utility in predicting response. However, the stability of pain catastrophizing as a static predictor has been challenged. We assess, among patients undergoing steroid injections for chronic low back pain (cLBP), whether catastrophizing changes with the clinical response to pain interventions.

Methods: This prospective study enrolled patients undergoing fluoroscopic-guided injections for cLBP. Patients filled out Brief Pain Inventory (BPI) and Pain Catastrophizing Scale (PCS) at baseline and 1-month follow-up. We assessed the change in PCS scores from pre-injection to post-injection and examined its predictors. We also examined the correlation of various domains of BPI, such as pain severity and effect on Relationships, Enjoyment, and Mood (REM), with PCS scores at baseline and follow-up.

Results: 128 patients were enrolled. Mean (SD) PCS and pain severity scores at baseline were 22.38 (±13.58) and 5.56 (±1.82), respectively. Follow-up PCS and pain severity scores were 19.76 (±15.25) and 4.42 (±2.38), respectively. The change in PCS pre-injection to post-injection was not significant (p=0.12). Multiple regression models revealed baseline PCS and REM domain of BPI as the most important predictors of change in PCS after injection. Pain severity, activity-related pain, age, sex, insurance status, depression, prior surgery, opioid use, or prior interventions did not predict change in PCS score. In correlation analysis, change in PCS was moderately correlated with change in pain (r=0.38), but weakly correlated with baseline pain in all pain domains.

Conclusions: PCS showed non-significant improvement following steroid injections; the study was not powered for this outcome. Follow-up PCS scores were predicted by the REM domain of BPI, rather than pain severity. Larger studies are needed to evaluate a statistically significant and clinically meaningful change in catastrophizing scores following pain interventions.

Keywords: back pain; chronic pain; injections, spinal.