The association of payer type and opioid use on functional improvement at short-term follow-up after lumbosacral transforaminal epidural steroid injection: Results of a large registry study

Raquel Reisinger; Marc Caragea; Masaru Teramoto; Hank Shipman; Dennis Berry-Rieser; Muna Oli; Richard Kendall; Taylor Burnham; Aaron Conger; Zachary McCormick

doi:10.1016/j.inpm.2022.100073

The association of payer type and opioid use on functional improvement at short-term follow-up after lumbosacral transforaminal epidural steroid injection: Results of a large registry study

Interv Pain Med. 2022 Feb 17;1(2):100073. doi: 10.1016/j.inpm.2022.100073. eCollection 2022 Jun.

Authors

Affiliations

¹ Department of Human Genetics, Utah Center for Genetic Discovery, University of Utah, Salt Lake City, UT, USA.
² School of Medicine, University of Utah, Salt Lake City, UT, USA.
³ Department of Physical Medicine and Rehabilitation, University of Utah Health, Salt Lake City, UT, USA.

Abstract

Background: Lumbosacral transforaminal epidural steroid injection (LTFESI) is a commonly performed intervention for treating radicular pain. While factors that predict pain improvement after LTFESI have been evaluated, minimal literature exists regarding predictors of functional improvement.

Purpose: To identify factors that are associated with functional improvement at short-term follow-up after LTFESI.

Study design: Retrospective review of prospectively collected registry data.

Patient sample: Patients undergoing LTFESI at an academic spine center who completed an Oswestry Disability Index (ODI) questionnaire both pre-procedure and one to three weeks post-procedure.

Outcome measures: The outcomes of interest were the proportions of patients who experienced a minimal clinically important difference (MCID) in function defined as ≥ 30% improvement in ODI score, as well as ≥ 10-point and ≥15-point improvement in ODI score.

Methods: Logistic regression analysis was performed to examine the associations of predictor variables to the ODI responder/non-responder outcome variable. The predictor variables for the analysis included: age, baseline ODI score, Charleston Comorbidity Index (CCI), payer type, prior lumbosacral spine surgery, pre-injection opioid use, two-level injections, bilateral injections, repeat injection, trainee presence during injection, immediate numerical rating scale (NRS) change post-injection. An odds ratio (OR) and its 95% confidence intervals (CIs) were calculated.

Results: A total of 606 patients were included in the analysis. More than half of the patients (56.8%) reported a ≥7.1% improvement in ODI score, and about 30% reported a ≥30% improvement in ODI score. Approximately 36% and 20% of the patients reported ≥10-point and ≥15-point reductions in ODI score, respectively. Medicaid and Medicare payer type and pre-injection opioid use were significantly associated with a lower likelihood of ≥30%, and ≥15-point improvements in ODI, after adjusting for the other factors (p < 0.05).

Conclusions: When using various common definitions of MCID for ODI score improvement, Medicaid, Medicare, and pre-injection opioid use were identified as factors that are negatively associated with functional improvement at short-term follow-up after LTFESIs.

Keywords: ESI; Insurance; Low back pain; MCID; ODI; Pain medicine; Radicular pain; Spine.