Predictors of Pain Recurrence After Lumbar Facet Joint Injections

Wuilker Knoner Campos; Marcelo Neves Linhares; Jamir Sarda; Adair Roberto Soares Santos; Kátia Lin; Alexandra Latini; Roger Walz

doi:10.3389/fnins.2019.00958

Predictors of Pain Recurrence After Lumbar Facet Joint Injections

Front Neurosci. 2019 Sep 20:13:958. doi: 10.3389/fnins.2019.00958. eCollection 2019.

Authors

Wuilker Knoner Campos^{1

2

3

4}, Marcelo Neves Linhares^{1

2

3

4

5}, Jamir Sarda⁶, Adair Roberto Soares Santos⁷, Kátia Lin^{4

8}, Alexandra Latini^{4

9}, Roger Walz^{4

8}

Affiliations

¹ Functional Neurosurgery Division, Department of Neurosurgery, Baia Sul Medical Center, Florianópolis, Brazil.
² Neuron Institute, Baia Sul Medical Center, Florianópolis, Brazil.
³ Neurosurgery Division, Hospital Governador Celso Ramos, Florianópolis, Brazil.
⁴ Center for Applied Neuroscience (CeNAp), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.
⁵ Department of Surgery, Neurosurgery Division, HU, UFSC, Florianópolis, Brazil.
⁶ Department of Psychology and Master Program of Health and Work, Univali, Itajaí, Brazil.
⁷ Department of Physiology, UFSC, Florianópolis, Brazil.
⁸ Department of Internal Medicine, Neurology Division, HU, UFSC, Florianópolis, Brazil.
⁹ Laboratory of Bioenergetics and Oxidative Stress, Department of Biochemistry, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.

Abstract

Introduction: Facet joint injections (FJIs) of anesthetic and corticosteroids are useful for the diagnosis and treatment of low back pain (LBP). In the current study, we evaluated the efficacy of FJI on LBP treatment and the predictive variables of pain recurrence after FJI.

Methods: We included and followed prospectively forty-three consecutive patients with chronic LBP treated with FJI. Clinical assessments were carried out at a baseline 1 week before FJIs and after a 6-month follow-up visit using the visual analog scale (VAS) for pain, Oswestry Disability Index (ODI) for disability-specific measure and MacNab criteria for global effectiveness, and compared through analysis using paired-samples "t" tests. Multiple cox-regression analysis was used to identify the presurgical variables independently associated with pain recurrence anytime during the follow-up. In addition to the demographic, clinical, and surgical data, we also analyzed psychometric scales: Pain Catastrophizing Scale (PCS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI).

Results: After a 6-month follow-up, thirty-two patients (74.4%) showed a clinically significant reduction of pain and twenty-seven (62.8%) reported a clinically significant improvement of disability. Presurgical catastrophizing (PCS score ≥ 5, adjusted HR 4.4, CI 95% 1.7-11.3, p = 0.002) and smoking (Adjusted HR 12.5, CI 95% 1.1-138.9, p = 0.04) remains associated with pain recurrence.

Conclusion: FJI reduces LBP and disability of patients with unresponsive LBP. Pain-related cognitive and behavioral factors determined by pain catastrophizing and smoking were independently associated with pain recurrence after lumbar FJI. The results support the need of a multidisciplinary approach for presurgical evaluation of patients with chronic pain.

Keywords: catastrophizing; disability; facet joint injection; facet joint pain; low back pain; psychological factors; spine.