Association of Protein and Genetic Biomarkers With Response to Lumbar Epidural Steroid Injections in Subjects With Axial Low Back Pain.
Stephen Schaaf, Wan Huang, Subashan Perera and 11 others
PMID 32576742WHAT IT FOUND
Patients who got 50% pain relief after lumbar epidural steroid injection had higher baseline NPY and serotonin, lower CS846, and certain COMT variants.
These markers were not tested to guide care.
Key findings
01At follow-up, 17 patients met the 50% pain-reduction responder definition, and 31 patients did not.
02Responders had lower baseline CS846 and higher NPY and serotonin than nonresponders.
03The COMT rs4680 variant allele was associated with increased odds of response, and the COMT ACCG haplotype occurred more often in nonresponders.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study included 48 patients and was exploratory, so the biomarker findings need confirmation. Most participants were white, which limits generalizability and may overrepresent certain genetic variants. Response was assessed only at about 2-week follow-up, using patient-reported pain reduction, so longer-term function and objective outcomes were not evaluated. The biomarkers are not readily available for clinical use, and the study shows association, not mechanism. Injection components and approaches varied, and the study did not separate the contribution of steroid, lidocaine, saline, or contrast.
The easy way to misread this
Do not conclude that these blood or genetic markers can guide treatment decisions. The study is exploratory, the biomarkers are not readily available for clinical use, and it did not test whether changing them improves outcomes. Do not conclude that steroid alone caused the response, because the injections also included contrast guidance and, depending on approach, lidocaine or saline.