Rapid screening test predicts effectiveness of steroid injections for neck pain
Researchers from Johns Hopkins Medicine and several other institutions say they have developed a quick clinical test that predicts which people with neck pain are more likely to benefit from epidural steroid injections, which deliver drugs directly around the spinal nerves to stop nerve inflammation and reduce pain.
The uncomfortable injections are a common treatment for neck pain, but can cost hundreds of dollars each; carry risks, and help only a minority of patients, studies show. A new variation on physical exam, as described Feb. 15 in Mayo Clinic Proceedings among 78 people with neck pain, could help guide best use of the treatment.
In the new study, collaborators adapted Waddell signs — a group of eight physical signs, named for the physician who developed them, more than 50 years ago, as a tool to identify patients whose back pain may not be due to physical abnormalities that can be treated surgically —for neck pain patients. The signs, which can be assessed in a few minutes by a clinician, include checking for tenderness; overreaction to light stimulation; weakness not clearly explained by any physical injury or abnormality; pain that disappears when the patient is distracted; and pain that extends beyond expected areas of the body.
Some of the individual Waddell signs were highly correlated with a lack of response to the injections. For example, 55% of injection nonresponders showed apparent overreactions to light touch, while only 11% of those helped by the injections showed this sign. The researchers also found that people with more non-organic signs associated with their neck pain were more likely to report chronic pain in other areas of the body, as well as fibromyalgia and psychiatric conditions.
