Low back pain patients unresponsive to an epidural steroid injection: identifying predictive factors

Clin J Pain. 1991 Dec;7(4):311-7. doi: 10.1097/00002508-199112000-00010.


This study examined factors that help to identify low back pain patients who do not benefit from a lumbar epidural steroid injection (LESI). Two-hundred and forty-nine chronic low back pain patients assessed their pain intensity before, 1 day after, and 2 weeks after receiving a LESI. All patients completed a comprehensive pain questionnaire and a Brief Symptom Inventory (BSI) prior to treatment. Diagnosis and extent of pathology were independently assessed by two physicians. One-hundred and thirty-one patients (52.6%) were followed 1 year after treatment. Results showed that average pain intensity ratings decreased in 62.3% of patients 2 weeks after receiving a LESI. One year after treatment, 62.6% felt that LESI was helpful. Nine patients (7%) felt that the treatment was harmful. Four factors were identified that best predicted poor outcome 2 weeks after LESI: (a) greater number of previous treatments for pain; (b) more medications taken; (c) pain not necessarily increased by activities, and (d) pain increased by coughing. Factors that predicted no benefit 1 year after treatment included (a) pain does not interfere with activities; (b) unemployment due to pain; (c) normal straight-leg raise test prior to treatment; and (d) pain not decreased by medication.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesia, Epidural*
  • Back Pain / complications
  • Back Pain / drug therapy*
  • Back Pain / psychology
  • Electrophysiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement
  • Prognosis
  • Regression Analysis
  • Steroids / administration & dosage
  • Steroids / therapeutic use*
  • Treatment Outcome


  • Steroids