• Cohen Steven SP 0000-0001-5928-2127 Department of Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA s, Doshi Tina TL Department of Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Dawson Timothy TC Pain Medicine, VA Puget Sound Health Care System, Seattle, Washington, USA., Anita Gupta, Shravani Durbhakula, Octav C Constantinescu, Jacobs Michael MB Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA., Verdun Aubrey V JV Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA., Mariam Salisu-Orhurhu, Scott R Griffith, and Connie Kurihara.
• Department of Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA scohen40@jhmi.edu.
• Reg Anesth Pain Med. 2019 May 1; 44 (5): 586-594.

BackgroundStudies have found that diffuse pain, indicative of central sensitization, portends poor interventional outcomes. Multiple chemical sensitivities are associated with signs of central sensitization. We sought to prospectively determine whether hypersensitivity reactions (HR) were associated with epidural steroid injection (ESI) outcomes.MethodsHR were classified as immune-related or non-immune-related and categorized by number (0=low, 1 or 2=intermediate, ≥3=high). The primary outcome measure was mean reduction in average leg pain score 1 month post-procedure. A positive outcome was defined as a two-point or greater decrease in average leg pain accompanied by satisfaction 1 month post-procedure.ResultsThe mean number of immune-mediated and non-immune-mediated HR were 0.6±1.2 and 0.8±1.4, respectively. Individuals in the high (n=24) total HR group had a mean reduction in average leg pain of 0.1±2.7, compared with those in the low (n=61; 1.8±2.1, p=0.025) and intermediate groups (n=52; 1.6±3.1, p=0.060). For back pain and categorical successful outcome, those with fewer HR experienced greater benefit. There were no differences in outcomes when patients were stratified by immune-related HR. Among participants in the low, intermediate and high non-immune-mediated HR groups, the mean reductions in average leg pain scores were 1.7±2.5, 1.6±3.0, and -0.2±2.3, respectively (p = 0.002). 51%, 35%, and 12% of people with low, intermediate and high numbers of non-immune-mediated HR experienced a positive categorical outcome, respectively (p=0.007).ConclusionsNon-immune-related HR were inversely correlated with some ESI outcome measures.© American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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