Abstract
Objective
To determine the association between cervical nonorganic pain signs and epidural corticosteroid
injection outcomes and coexisting pain and psychiatric conditions.
Patients and Methods
Seventy-eight patients with cervical radiculopathy who received epidural corticosteroid
injection were observed to determine the effects that nonorganic signs have on treatment
outcome. A positive outcome was a decrease of 2 or more points in average arm pain,
coupled with a score of 5 on a 7-point Patient Global Impression of Change scale 4
weeks after treatment. Nine tests in 5 categories (abnormal tenderness, regional disturbances
deviating from normal anatomy, overreaction, discrepancies in examination findings
with distraction, and pain during sham stimulation) were modified from previous studies
and standardized. Other variables examined for their association with nonorganic signs
and outcomes included disease burden, psychopathology, coexisting pain conditions,
and somatization.
Results
Of the 78 patients, 29% (n=23) had no nonorganic signs, 21% (n=16) had signs in 1
category, 10% (n=8) had signs in 2 categories, 21% (n=16) had signs in 3 categories,
10% (n=8) had signs in 4 categories, and 9% (n=7) had signs in 5 categories. The most
common nonorganic sign was superficial tenderness (44%; n=34). Mean number of positive
nonorganic categories was higher in individuals with negative treatment outcomes (2.5±1.8;
95% CI, 2.0 to 3.1) compared with those with positive outcomes (1.1±1.3; 95% CI, 0.7
to 1.5; P=.0002). Negative treatment outcomes were most strongly associated with regional disturbances
and overreaction. Positive associations were noted between nonorganic signs and multiple
pain (P=.011) and multiple psychiatric (P=.028) conditions.
Conclusion
Cervical nonorganic signs correlate with treatment outcome, pain, and psychiatric
comorbidities. Screening for these signs and psychiatric symptoms may improve treatment
outcomes.
Trial Registration
ClinicalTrials.gov identifier: NCT04320836.
Abbreviations and Acronyms:
AIS (Athens Insomnia Scale), ANOVA (analysis of variance), ECI (epidural corticosteroid injection), HADS (Hospital Anxiety and Depression Scale), LBP (low back pain), NDI (Neck Disability Index), PGIC (Patient Global Impression of Change), SSS-8 (8-item Somatic Symptom Scale)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 15, 2023
Publication stage
In Press Corrected ProofFootnotes
Grant Support: Funded in part by a grant from MIRROR, Uniformed Services University of the Health Sciences, U.S. Department of Defense (HU00011920011). The sponsor did not play a role in study design or performance or in analysis or interpretation of data.
Identification
Copyright
© 2022 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
