Background: Results of the lumbar transforaminal epidural steroid injection (L-TFESI) used in
the treatment of lumbar radiculopathy may be affected by the current psychiatric condition of
the patient.
Objectives: The study aimed to assess the effects of pretreatment comorbid psychiatric
conditions on patient outcomes in patients with lumbar disc herniation and radiculopathy.
Study Design: The study used a prospective-observational study design.
Setting: Research was conducted at a university hospital international pain management
center.
Methods: In this observational study, 103 patients were included. All patients were evaluated
with the Hospital Anxiety and Depression scale (HADS) for depression and anxiety levels and
the Somatosensory Amplification Scale (SSAS) for somatization levels before the L-TFESI.
The treatment results were evaluated with the Numeric Rating Scale (NRS) and the Oswestry
Disability Index (ODI) at baseline, the third week, and the third month. Relative to baseline, a
50% reduction in the NRS was accepted as a successful treatment.
Results: HADS-depression, HADS-anxiety, and SSAS levels were similar between the patients
with successful treatment outcome and the patients in whom treatment failed. However, there
were negative correlations between percent reduction in the NRS and the HADS-depression
levels at 3 weeks (r = -0.182, P = .022) and 3 months (r = -0.204, P = .037). Also, there were
positive correlations between patients’ pre-injection ODI scores and both the HADS-anxiety (r =
0.271, P = .001) and SSAS (r = 0.201, P = .013) scores.
Limitations: The study was limited by a relatively short-term follow-up period.
Conclusions: Although psychiatric conditions affected the pain and disability of patients
before and after the L-TFESI, and may have an impact on patient-related outcomes, they should
not be a reason to not treat patients or expect a lower chance of success.
Key words: Anxiety, depression, disc herniation, low-back pain, lumbar radiculopathy, patientrelated outcomes, somatization, transforaminal epidural steroid injection
The Effect of Pre-Treatment Depression, Anxiety
and Somatization Levels on Transforaminal
Epidural Steroid Injection: A Prospective
Observational Study
