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Adjuvant administration of hypertonic saline in lumbar epidural intervention may be associated with successful response in patients with probable neuropathic radicular pain Screened by Douleur Neuropathique 4

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Abstract
Background: Chronic lumbar radicular pain often accompanies neuropathic pain. The treatment may follow a screening for probable neuropathic pain rather than the definitive diagnosis, which is often difficult in daily practice. However, interventional management may have limited effects on symptoms in patients with neuropathic radicular pain refractory to conservative treatments. The purpose of this study is to evaluate the factors associated with successful responses after lumbar epidural intervention in patients with chronic lumbar neuropathic radicular pain determined by Douleur Neuropathique 4 (DN4). Methods: We retrospectively reviewed 221 chronic lumbar radicular pain patients using a DN4 questionnaire prior to the epidural interventional procedure. The patients were divided into two groups according to the DN4 questionnaire: <4-point DN4 and >= 4 DN4. The numerical rating scale (NRS) for pain intensity, changes in physical functional status, and the use of pain medication were obtained before and 1 month after the procedure. Successful responder was defined based on robust combination of outcome parameters. The factors associated with successful response were analyzed using univariate and multivariate regression. Results: We found 170 (76.9%) patients with DN4 <4 and 51 (23.1%) with a score >= 4. Among the total 221 patients, 129 (58.4%) were successful responders and 92 (41.6%) were non-responders regardless of DN4 score. We observed a significantly lower proportion of successful responders among patients with a DN4 score >= 4 (22, 43.1%) than patients with a score <4 (107, 62.9%) (P=0.012). After adjusting in multivariate regression analysis, the DN4 score was independently associated with response after lumbar epidural intervention (odds ratio [OR]=0.838; 95% confidence interval [CI]=0.718-0.978; P=0.025). In subgroup logistic regression analysis according to the DN4 score, adjuvant administration of hypertonic saline during epidural interventions in patients with a DN4 score >= 4 (OR=3.71; CI=1.142-12.457; P=0.029) was associated with the success of the lumbar epidural procedure at 1 month. Conclusion: The adjuvant use of hypertonic saline in lumbar epidural interventions may be effective at least 1 month after the intervention in patients with probable neuropathic lumbar radicular pain >= 4 using the DN4.
Author(s)
김선민신진우이용수임정길최성수
Issued Date
2021
Type
Article
Keyword
AnalgesicsBack painBody mass indexchronic painDouleur Neuropathique 4Electronic health recordsEpiduralhypertonic salineInterventionlumbarMedical recordsneuropathic painPatientsPhysical therapyQuestionnairesradicular painRegression analysisResearch PaperSurgery
DOI
10.7150/ijms.59695
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7276
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8176191&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Adjuvant%20administration%20of%20hypertonic%20saline%20in%20lumbar%20epidural%20intervention%20may%20be%20associated%20with%20successful%20response%20in%20patients%20with%20probable%20neuropathic%20radicular%20pain%20Screened%20by%20Douleur%20Neuropathique%204&amp;offset=0&amp;pcAvailability=true
Publisher
INTERNATIONAL JOURNAL OF MEDICAL SCIENCES
Location
오스트레일리아
Language
영어
ISSN
1449-1907
Citation Volume
18
Citation Number
12
Citation Start Page
2736
Citation End Page
2742
Appears in Collections:
Medicine > Medicine
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