The value of short-term pain relief in predicting the long-term outcome of 'indirect' cervical epidural steroid injections.

BACKGROUND: The predictive value of short-term arm pain relief after 'indirect' cervical epidural steroid injection (ESI) for the 1-month treatment response has been previously demonstrated. It remained to be answered whether the long-term response could be estimated by the early post-interventional pain course as well. METHODS: Prospective observational study, following a cohort of n = 45 patients for a period of 24 months after 'indirect' ESI for radiculopathy secondary to a single-level cervical disk herniation (CDH). Arm and neck pain on the visual analog scale (VAS), health-related quality of life with the Short Form-12 (SF-12), and functional outcome with the Neck Pain and Disability (NPAD) Scale were assessed. Any additional invasive treatment after a single injection (second injection or surgery) defined treatment outcome as 'non-response'. RESULTS: At 24 months, n = 30 (66.7%) patients were responders and n = 15 (33.3%) were non-responders. Non-responders exited the follow-up at 1 month (n = 10), at 3 months (n = 4), and at 6 months (n = 1). No patients were injected again or operated on between the 6- and 24-month follow-up. Patients with favorable treatment response at 24 months had significantly lower VAS arm pain (p < 0.05) than non-responders at days 6, 8-11, and at the 3-month follow-up. The previously defined cut-off of > 50% short term pain reduction was not a reliable predictor of the 24-month responder status. SF-12 and NPAD scores were better among treatment responders in the long term. CONCLUSIONS: Patients who require a second injection or surgery after 'indirect' cervical ESI for a symptomatic CDH do so within the first 6 months. Short-term pain relief cannot reliably predict the long-term outcome.

The Value of Short-Term Pain Relief in Predicting the Long-Term Outcome of Lumbar Transforaminal Epidural Steroid Injections.

BACKGROUND: A previous report demonstrated predictive power of short-term leg pain relief after lumbar transforaminal epidural steroid injections for 1-month treatment response. The question whether the long-term response could be similarly predicted remained unanswered. METHODS: A prospective cohort of 57 patients who underwent a transforaminal epidural steroid injection for sciatica secondary to a lumbar disc herniation was followed for 24 months. Leg and back pain on the visual analog scale, health-related quality of life using the 12-Item Short Form Survey, and functional outcome using the Oswestry Disability Index were assessed. Responders were defined as not receiving any additional invasive treatment after a single injection. Patients who underwent a second injection or surgery were defined as treatment failures (nonresponders). RESULTS: At 24 months, 31 (54.4%) patients were responders, and 26 (45.6%) were nonresponders. Nonresponders left follow-up at 1 month (n = 9), 3 months (n = 9), 6 months (n = 6) and 12 months (n = 2). No patients were injected again or operated on between the 12- and 24-month follow-up. Responders at 24 months had significantly lower visual analog scale leg pain (P < 0.05) than nonresponders starting from the second week after TFESI and better 12-Item Short Form Survey scores and less disability on the Oswestry Disability Index. CONCLUSIONS: Most patients with a symptomatic lumbar disc herniation who opt for a second injection or surgery do so within the first 6 months. Reliable prediction of the long-term treatment response based on short-term pain relief is not possible.

The value of short-term pain relief in predicting the 1-month outcome of 'indirect' cervical epidural steroid injections.

BACKGROUND: Clinical management after epidural steroid injections (ESI) of patients with radiculopathy secondary to a cervical disc herniation (CDH) is uncertain. This study aims to determine whether short-term arm pain alleviation following computed tomography-guided 'indirect' cervical ESI can predict the 1-month outcome. METHODS: We conducted a prospective observation of 45 consecutive patients at a tertiary radiological department. Study components were visual analog scale arm and neck pain at baseline, 15, 30, and 45 min, 1, 2, and 4 h, on days 1-14, 1 month, and at 1 year. Health-related quality of life and functional impairment were assessed using the short form-12 and Neck Pain and Disability Scale. Patients who reported ≥80 % persisting arm pain, as well as patients who underwent a second injection or an operation within 1 month were defined as 'non-responders'. Logistic regression was used to analyze the effect size of the relationship between >50 % pain relief at any given study visit and responder status. RESULTS: Patients experiencing a >50 % pain reduction 4 h after the injection were four times as likely to be responders as those experiencing ≤50 % pain reduction (OR 4.04, 95 % CI 1.10-14.87). The effect was strongest on days 5-6 (OR 18.37, 95 % CI 3.39-99.64) and remained significant until day 14. CONCLUSIONS: The results of this study can guide physicians in managing patients with CDH: a ≤50 % arm pain relief within 1 week after an 'indirect' cervical ESI predicts an unfavorable 1-month outcome and suggests that other treatment options may be considered at an earlier point in time.

The Value of Short-Term Pain Relief in Predicting the One-Month Outcome of Lumbar Transforaminal Epidural Steroid Injections.

BACKGROUND: Clinical management after epidural steroid injections of patients with radiculopathy secondary to a lumbar disc herniation is uncertain. It is the aim of this study to determine whether short-term alleviation of leg pain after computed tomography-guided transforaminal epidural steroid injections can predict the 1-month outcome. METHODS: Prospective observational study of 57 patients at a tertiary radiological department. Study components were visual analog scale leg and back pain at baseline, 15, 30, 45 minutes, 1, 2, and 4 hours, on days 1-14, as well as at 1 month. Health-related Quality of Life and functional impairment were assessed with the Short Form-12 and Oswestry Disability Index. Patients who reported >80% persisting leg pain, as well as patients who underwent a second injection or an operation within 1 month, were defined as nonresponders. Logistic regression was used to analyze the effect size of the relationship between >50% pain relief at any given study visit and responder status. RESULTS: Patients experiencing a >50% pain reduction 4 hours after the injection were 3.38 times as likely to be responders as those experiencing ≤50% pain reduction (odds ratio 3.38, 95% confidence interval 1.07-10.65). The effect decreased between days 1 and 2, reappeared on day 3, was strongest on day 6 (odds ratio 6.87, 95% confidence interval 1.99-23.72), and remained significant until day 14. CONCLUSIONS: The results of this study can guide physicians in managing patients with lumbar disc herniation: a ≤50% leg pain relief within 1 week after a transforaminal epidural steroid injection predicts an unfavorable 1-month outcome and suggests that other treatment options may be considered.

Georg Büchner, Sigmund Freud and the "Schädelnerven" (cranial nerves) - research on the brain and soul in the 19th century.

BACKGROUND: One of the authors' encounter with one of Sigmund Freud's original works about the anatomy of the human brain stem and his interest in the scientist, anatomist, philosopher, writer and revolutionary Georg Büchner led to re-examination and review of the original writings of two major 19th century protagonists of brain anatomy research. The aim of the authors is to highlight the achievements of both Freud and Büchner in the field of comparative brain morphology. METHODS: The medical and philosophical publications of Georg Büchner were reviewed with reference to the historical-critical edition of his complete works and writings (the so-called Marburg edition). Evaluation of the neuroanatomical achievements of Sigmund Freud was based on a summary of his publications and also partially on his autobiographical writings. RESULTS: After careful review of their publications both Freud and Büchner should be acknowledged as brain scientists focusing particularly on comparative morphology. Both chose fish as the subject of their macroscopic (Büchner) and microscopic (Freud) neuroanatomical studies, and both cut across their own language and cultural space by continuing their work in France. In interpreting their findings both were influenced by their respective contemporary methodological schools of thought. Büchner became a soul scientist/psychologist by turning to the writing of literary texts, heralding the end of his idealistic and metaphysical interpretation of life. Likewise, Freud increasingly devoted himself to the destiny of man and his "conditio humana," eventually turning away from anatomical brain research. CONCLUSION: Review of the biographies and medical-scientific, as well as philosophical publications, of Georg Büchner and Sigmund Freud reveal striking parallels between the two researchers in addition to common insights that have generally been ignored or only marginally addressed in the past. Both should be appreciated and remembered as forerunners of today's neuroscientific community.