Transforaminal epidural steroid injections may be more effective in relieving pain in patients with mild to moderate vs severe lower extremity radicular pain associated with lumbar foraminal spinal stenosis (LFSS), according to an observational study reported in Pain Physician.

Participants were subdivided into a mild to moderate LFSS group (n=31) and a severe LFSS group (n=26); 3 patients were lost at follow-up. A numeric rating scale (NRS) was used to assess pain intensity at baseline as well as at 1, 2, and 3 months after intervention.

NRS scores were reduced in both patient groups at each follow-up month. Participants with mild to moderate LFSS reported a greater reduction in pain intensity over time compared with patients with severe LFSS (P =.023). 

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The decrease in pain intensity was greater in patients with mild to moderate vs severe manifestations of LFSS at 1 month (P =.044), 2 months (P =.021), and 3 months (P =.017). At the 3-month follow-up, 87.1% of patients with mild to moderate LFSS reported pain relief ≥50% vs 42.3% in the severe LFSS group. In addition, participants with mild to moderate stenosis reported higher treatment satisfaction compared with participants with severe LFSS.

The study’s small sample size, short follow-up, and lack of functional status measurement represent study limitations.

“Our study can give clinicians useful information for establishing a treatment plan for radicular pain induced by LFSS,” concluded the investigators.

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Chang MC, Lee DG. Outcome of transforaminal epidural steroid injection according to the severity of lumbar foraminal spinal stenosis. Pain Physician. 2018;21(1):67-72.