Evidence map›Paper›PMID 36803892›Full record

ArticleMayo Clinic proceedings2023

Nonorganic (Behavioral) Signs and Their Association With Epidural Corticosteroid Injection Treatment Outcomes and Psychiatric Comorbidity in Cervical Radiculopathy: A Multicenter Study.

Steven P Cohen, Tina L Doshi, Edward Dolomisiewicz, David E Reece, Zirong Zhao, Mirinda Anderson-White, Angelia Kasuke, Eric J Wang, Annie Hsu, Shelton A Davis and 3 more

Registry-linked trialOpen access · greenAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Mayo Clinic proceedings, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04320836 (Prospective Study to Determine Evaluate the Validity and Predictive Ability of Physical Exam Signs for Cervical Radiculopathy to Predict Epidural Steroid Injection), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.7field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04320836 completednot on this map

Prospective Study to Determine Evaluate the Validity and Predictive Ability of Physical Exam Signs for Cervical Radiculopathy to Predict Epidural Steroid Injection (ESI) Treatment Outcomes.

TypeobservationalSponsorJohns Hopkins UniversityRan2020 to 2022Enrolled78ConditionsCervical Radiculopathy, Cervical Radicular PainArmsCervical epidural steroid injection
3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 3 citations in OpenAlex.

  1. Review
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 3 institutions in 2 countries.

Steven P CohenDepartment of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD. Electronic address: scohen40@jhmi.edu.
Tina L DoshiDepartment of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins University School of Medicine, Baltimore, MD.
Edward DolomisiewiczDepartment of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD.
David E ReeceDepartment of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD.
Zirong ZhaoDepartments of Neurology and Internal Medicine, District of Columbia Veterans Affairs Medical Center, Washington, DC.
Mirinda Anderson-WhiteDepartment of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins University School of Medicine, Baltimore, MD.
Angelia KasukeDepartment of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD.
Eric J WangDepartment of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins University School of Medicine, Baltimore, MD.
Annie HsuDepartment of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins University School of Medicine, Baltimore, MD.
Shelton A DavisDepartment of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD.
Yongjae YooDepartment of Anesthesiology, Seoul National University, Seoul, Korea.
Paul F PasquinaDepartment of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD.
Jee Youn MoonDepartment of Anesthesiology, Seoul National University, Seoul, Korea.
Johns Hopkins University · USUniformed Services University of the Health Sciences · USSeoul National University · KR

Funding

Increasing Participant Diversity in a 'Sequenced-Strategy to Improve Outcomes in people with Knee Osteoarthritis Pain (SKOAP)UH3AR077360 · NIAMS · JOHNS HOPKINS UNIVERSITY · PI CAMPBELL, CLAUDIA MICHELLE, CASTILLO, RENAN C · 2020 to 2023
$13.8M
Mentorship of Junior Investigators on HEAL-SKOAPK24AR081143 · NIAMS · JOHNS HOPKINS UNIVERSITY · PI CAMPBELL, CLAUDIA MICHELLE · 2021 to 2021
$324k
NIAMS NIH HHS K24 AR081143NIAMS NIH HHS UH3 AR077360
6 · The paper itself

Abstract

objectiveTo determine the association between cervical nonorganic pain signs and epidural corticosteroid injection outcomes and coexisting pain and psychiatric conditions. PATIENTS AND

methodsSeventy-eight patients with cervical radiculopathy who received epidural corticosteroid injection were observed to determine the effects that nonorganic signs have on treatment outcome. A positive outcome was a decrease of 2 or more points in average arm pain, coupled with a score of 5 on a 7-point Patient Global Impression of Change scale 4 weeks after treatment. Nine tests in 5 categories (abnormal tenderness, regional disturbances deviating from normal anatomy, overreaction, discrepancies in examination findings with distraction, and pain during sham stimulation) were modified from previous studies and standardized. Other variables examined for their association with nonorganic signs and outcomes included disease burden, psychopathology, coexisting pain conditions, and somatization.

resultsOf the 78 patients, 29% (n=23) had no nonorganic signs, 21% (n=16) had signs in 1 category, 10% (n=8) had signs in 2 categories, 21% (n=16) had signs in 3 categories, 10% (n=8) had signs in 4 categories, and 9% (n=7) had signs in 5 categories. The most common nonorganic sign was superficial tenderness (44%; n=34). Mean number of positive nonorganic categories was higher in individuals with negative treatment outcomes (2.5±1.8; 95% CI, 2.0 to 3.1) compared with those with positive outcomes (1.1±1.3; 95% CI, 0.7 to 1.5; P=.0002). Negative treatment outcomes were most strongly associated with regional disturbances and overreaction. Positive associations were noted between nonorganic signs and multiple pain (P=.011) and multiple psychiatric (P=.028) conditions.

conclusionCervical nonorganic signs correlate with treatment outcome, pain, and psychiatric comorbidities. Screening for these signs and psychiatric symptoms may improve treatment outcomes.

trial registrationClinicalTrials.gov identifier: NCT04320836.

Indexed as

RadiculopathyAdrenal Cortex HormonesComorbidityHumansNeck PainTreatment OutcomeAdrenal Cortex Hormones

Identifiers

PMID36803892
PMCPMC10358758
OpenAlexW4320923002

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.