Scientists at Johns Hopkins University and Seoul National University have developed a rapid clinical test that predicts which people with neck pain may benefit from steroid injections into the space around their spinal nerves. The study is published in Mayo Clinic Proceedings .
An epidural injection delivers a pain reliever into the space around the spinal nerves. However, their use is associated with long-term health risks, and they help a minority of patients.
The researchers studied data from 78 people with neck pain who received epidural steroid injections. The researchers found that the presence of one of the eight Waddell signs in a patient is associated with the ineffectiveness of epidural steroid injections.
The eight Waddell signs, including the patient’s overreaction to light, lack of injury, reduction in pain with mental distraction, and others, are used to determine if pain is due to an anatomical cause. Previously, many doctors believed that the presence of these signs indicates simulation or psychological factors. However, recent research has shown that such Waddell signs may also indicate complex causes of pain.
On average, patients who were helped by steroid injections had half as many Waddell signs. Some of Waddell’s individual symptoms were particularly strongly correlated with injection failure. For example, 55% of patients who did not respond to injections experienced an overreaction to light touch. At the same time, only 11% of those who were helped by injections had this symptom.
The researchers also found that people with Waddell’s signs were more likely to report chronic pain elsewhere in the body, as well as fibromyalgia and mental illness.