Lisa Huynh, M.D.

All Publications

• Intra-articular cervical facet joint corticosteroid injections in patients with increased peri-facet MRI STIR signal. A prospective, multi-center case series. Interventional pain medicine Levin, J., Barrette, K., Ghaffari, C., Ehsanian, R., Koltsov, J., Giacomazzi, C., Prabhakar, N., Huynh, L., Smuck, M., Summers, W., Schneider, B. 2025; 4 (4): 100646

  Abstract

  Intra-articular cervical facet joint corticosteroid injections are commonly performed, yet studies demonstrating benefit are limited.To evaluate success rates of intra-articular cervical facet joint corticosteroid injections in patients with increased peri-facet edema as demonstrated by MRI with STIR sequences.Preliminary, prospective, multi-center case series.Thirty-three patients from three independent spine centers.Consecutive patients were enrolled with axial neck pain and peri-facet joint edema on MRI with STIR sequences when undergoing intra-articular cervical facet joint corticosteroid injections. Outcomes were prospectively collected at 2-4-weeks and at 3-months post-injection. The primary outcome was the proportion of patients with at least 50 % improvement in the numeric rating scale (NRS) pain score. Neck disability index (NDI) and global perception of change (GPC) were evaluated as secondary outcomes.At 2-4-weeks post-injection, 64 % [95 %CI: 46-79 %] of the 28 patients with follow-up data met criteria for success (≥50 % improvement in NRS). 86 % [95 %CI: 69-94 %] reported that they were better or much better on the GPC, and mean NDI improved from 19.3 to 8.9. At 3-months post-injection, 35 % [95 %CI: 19-54 %] of the 26 patients with follow-up data met criteria for success, and 50 % [95 %CI: 32-68 %] reported that they were better or much better on the GPC. Mean NDI at 3-months was 11.0.Intra-articular cervical facet joint corticosteroid injections may provide short-term relief of neck pain in patients with peri-facet edema as demonstrated by MRI with STIR sequences. Intermediate-term results are less encouraging.

  View details for DOI 10.1016/j.inpm.2025.100646

  View details for PubMedID 41143253

  View details for PubMedCentralID PMC12547228

• "Is this injection going to hurt?" Quantifying the pain experience during common lumbosacral spine injections. Interventional pain medicine Smuek, A., Bakshi, R., Mays, R., Huynh, L., Levin, J., Rittenberg, J., Smuck, M. 2025; 4 (3): 100632

  Abstract

  "Is this injection going to hurt?" Physicians typically answer this from experience since accurate answers are not available in the literature.To quantify pain during common lumbosacral spine injections and compare to baseline pain prior to the injections. Analyze differences based on demographic and procedure variables.This is a secondary analysis of prospectively collected data from a multicenter trial of patients undergoing bilateral symmetric transforaminal epidural (TFE), facet joint (FJ), or sacroiliac joint (SIJ) injections. Numeric pain ratings (0-10) were obtained at baseline in preop ("What is your current pain?") and for each injection procedure ("How much did this injection hurt from start to finish?") first on the right side then the left. Between group comparisons used Chi-squared and ANOVA for categorical and continuous variables, respectively. T-tests compared various pain responses, and multivariate regression determined factors associated with higher procedure pain.From 244 injections (124 TFE, 60 FJ, 60 SIJ) on 122 consecutive patients (mean age 57.2, 50 % female), age and BMI did not differ between injection groups while sex did (p = 0.001) with more FJ males and SIJ females. Mean baseline pain was statistically equivalent between demographic and injection groups. Mean procedure pain was consistently higher than mean baseline pain, however this difference was small and non-significant for TFE (4.0 vs 3.8) and FJ (3.9 vs 3.3), but larger and significant for SIJ (5.3 vs. 3.6; p = 0.0001). In the multivariate regression analysis only 2 variables remained associated with higher procedure pain, older age (p < 0.0001) and SIJ injection group (p = 0.0021).The majority of patients (79.1 %) report mild or moderate pain during common lumbosacral spine injections. The average procedure pain of 4.3 on the NPRS scale was only 0.7 points higher than baseline pain recorded in pre-op. Procedure pain from TFE and FJ injections is statistically equivalent to baseline pain and to each other, while SIJ injections produce higher procedure pain with a significant +1.7 point mean increase in pain from baseline. Finally, older adults report significantly greater procedure pain compared to those under 65 years old.

  View details for DOI 10.1016/j.inpm.2025.100632

  View details for PubMedID 40896548

  View details for PubMedCentralID PMC12396260

• Results of lumbar transforaminal epidural steroid injections based on the physician referral source. Interventional pain medicine Levin, J., Li, W., Gall, N., Chan, J., Caragea, M., Huynh, L., Koltsov, J., Smuck, M. 2022; 1 (3): 100114

  Abstract

  Background: Many patients who receive lumbosacral transforaminal epidural steroid injections (TFESIs) are referred for the injection from a physician who does not perform the procedure.Purpose: To compare success rates of fluoroscopically guided lumbosacral TFESIs in patients who had a clinical evaluation and recommendation for the injection by a fellowship-trained spine specialist who routinely performs ESIs (Group A), vs those who had a clinical evaluation by a fellowship-trained spine specialist who referred the patient for the procedure to be done by a different physician (Group B).Study design/setting: Retrospective, observational, in vivo study of consecutive patients. Patient.Sample: Patients undergoing lumbosacral TFESIs at a single outpatient academic spine center. Outcome.Measures: Numeric Rating Scale (NRS) pain score improvement.Methods: Current procedural terminology (CPT) codes were used to search all consecutive patients who received a lumbosacral TFESI between September 2019 and September 2020. All patients with pre- and post-injection NRS pain scores within 60 days of the injection were included in the analysis.Results: A total of 230 TFESIs were analyzed, 151 in Group A, and 79 in Group B. The primary outcome was defined as > 50% improvement in the NRS pain score. 39% [95% CI: 33, 45%] of all patients who received a lumbosacral TFESI achieved a successful outcome. There were better results in Group A with a 47% [95% CI: 39, 55%] success rate compared to a 23% [95% CI: 14, 32%] success rate in Group B. Group A also had a higher proportion of patients who achieved at least 80% pain relief (26% [95% CI: 19, 33%]) compared to Group B (10% [95% CI: 3, 17%]). History of prior surgery did not significantly affect outcomes.Conclusion: This retrospective study demonstrated a higher success rate from lumbosacral TFESIs when patients were referred for the injection by a physician who performs ESIs.

  View details for DOI 10.1016/j.inpm.2022.100114

  View details for PubMedID 39238527

• Retrospective analysis of cervical transforaminal versus interlaminar epidural steroid injections. Interventional pain medicine Levin, J., Chan, J., Gall, N., Koltsov, J., Huynh, L. 2022; 1 (2): 100102

  Abstract

  Background: Several studies have compared outcomes from lumbar epidural steroid injections (ESIs) based upon technique (transforaminal (TF) vs interlaminar (IL) vs caudal). However, little on this topic has been reported in the cervical spine, and results have been conflicting.Purpose: To compare success rates of fluoroscopically-guided cervical TFESIs vs ILESIs.Study design/setting: Retrospective, observational, in vivo study of consecutive patients at outpatient Physical Medicine & Rehabilitation clinics at a single academic spine center.Patient sample: Consecutive patients who received a cervical TF or IL ESI between January 2010 and October 2018.Outcome measures: NRS pain scores within 60 days of the ESI.Methods: Current procedural terminology (CPT) codes were used to search all consecutive patients at a single outpatient academic spine center who received a cervical TF or IL ESI between January 2010 October 2018. All patients with pre and post injection NRS pain scores within 60 days of the injection were included in the analysis.Results: A total of 178​TF and 185 ILESIs were analyzed. Success was defined as ≥ 50% improvement in NRS pain score. 52% [95% CI: 47 - 57%] of all patients receiving a cervical ESI achieved a successful outcome. There was a strong trend towards better results in the ILESI group with 59% [95% CI: 52 - 66%] of patients achieving at least 50% pain relief compared to 46% [95% CI: 39 - 53%] in the TF group. A higher proportion of patients in the IL group obtained at least 80% pain relief (37% [95% CI: 30 - 44%]) compared to those in the TF group (17% [95% CI: 11 - 23%]). Post-procedure median NRS pain scores, and improvement in median NRS pain scores were better in the ILESI group compared to the TFESI group (p<0.001).Conclusion: This retrospective study demonstrated better results in the cervical ILESI group compared to the cervical TFESI group.

  View details for DOI 10.1016/j.inpm.2022.100102

  View details for PubMedID 39239365

• The effect of patient satisfaction scores on physician clinical decision making: A possible factor driving utilization of opioid prescriptions, magnetic resonance imaging, and interventional spine procedures. Interventional pain medicine Schneider, B. J., Ehsanian, R., Kennedy, D. J., Schmidt, A., Huynh, L., Maher, D. P. 2022; 1 (1): 100012

  Abstract

  To survey the effect of patient satisfaction scores on pain physicians' medical decision making, with an emphasis on resource utilization.Email-based Survey.Setting & Subjects: A 23-question survey was approved for dissemination to membership of a medical society and emailed to all members. The survey was also available online and via a promoted QR code.An email with link to the survey was viewed 1,116 times, and clicked on 223 times, with 75 members completing the survey online once the link was clicked. Thirty-three additional physicians directly accessed the survey online and completed it. Seventy-seven percent of physicians reported that patient satisfaction scores were tracked by their institution and were used as a consideration in financial compensation (22%) or performance review (36%). Over half of the physicians surveyed reported feeling that satisfaction scores would decline if they did not order MRI imaging, prescribe opioids or provide work restrictions/disability. Thirty percent reported to have performed a spine injection due to concern about patient satisfaction scores. Twenty-one reported that they had prescribed an opioid medication because of this concern. Lastly 25% and 24% have filled out disability paperwork or provided a disability parking placard respectively.Over half of physicians surveyed reported having ordered physical therapy, MRIs, opioid medications, spine injections, or provided disability documentation over concern about how providing or not providing such things impacts patient satisfaction scores. This may be an unintended consequence of the current emphasis placed on patient satisfaction scores.

  View details for DOI 10.1016/j.inpm.2022.100012

  View details for PubMedID 39238821

  View details for PubMedCentralID PMC11373071

• Results of cervical epidural steroid injections based on the physician referral source. Interventional pain medicine Levin, J., Gall, N., Chan, J., Huynh, L., Koltsov, J., Kennedy, D. J., Smuck, M. 2022; 1 (1): 100001

  Abstract

  Many patients who receive cervical epidural steroid injections (ESIs) are referred for the injection from a physician who does not perform the procedure.To compare success rates of fluoroscopically-guided cervical ESIs in patients who had a clinical evaluation and recommendation for the injection by a fellowship-trained spine specialist who routinely performs ESIs (Group A), vs those who had a clinical evaluation by a fellowship-trained spine specialist who referred the patient for the procedure to be done by a different physician (Group B).Retrospective, observational, in vivo study of consecutive patients. Patient Sample. Patients undergoing cervical transforaminal (TF) or interlaminar (IL) ESIs at a single outpatient academic spine center.Numeric Rating Scale (NRS) pain score improvement.Current procedural terminology (CPT) codes were used to search all consecutive patients who received a cervical TF or IL ESI between January 2010 and October 2018. All patients with pre and post-injection NRS pain scores within 60 days of the injection were included in the analysis.A total of 363 ESIs were analyzed (178 ​TF and 185 IL). 275 patients were evaluated and referred for the injection by a spine specialist who performs these procedures (Group A), and 88 were evaluated and referred by a spine specialist who does not perform these procedures (Group B). Success was defined as > 50% improvement in the NRS pain score. 52% [95% CI: 47-57%] of all patients who received a cervical ESI achieved a successful outcome. There were better results in Group A with a 57% [95% CI: 51-63%] success rate compared to a 38% [95% CI: 28-48%] success rate in Group B. Group A also had a higher proportion of patients who achieved at least 80% pain relief (31% [95% CI: 26-36%]) compared to Group B (17% [95% CI: 9-25%]).This retrospective study demonstrated better results from cervical ESIs when patients were referred for the injection by a physician who performs ESIs. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

  View details for DOI 10.1016/j.inpm.2021.100001

  View details for PubMedID 40510260

  View details for PubMedCentralID PMC12161879

• Thoracic transforaminal epidural steroid injection for management of thoracic spine pain: A multicenter cross-sectional study of short-term outcomes. Interventional pain medicine Levin, J., Chan, J., Huynh, L., Smuck, M., Koltsov, J., Kesikburun, B., Wagner, G. E., Caragea, M., Kuo, K., McCormick, Z. L., Schneider, B., Berlin, E., Kennedy, D. J., Kesikburun, S. 2022; 1 (1): 100004

  Abstract

  Thoracic transforaminal epidural steroid injections (TFESIs) are procedures performed for the treatment of thoracic spine pain (TSP). The literature on these interventions is sparse.To report outcomes of thoracic TFESIs for TSP indications.Multicenter, retrospective, cross-sectional cohort study.Consecutive patients receiving thoracic TFESIs at three academic spine centers.The primary outcome was the proportion of patients reporting at least 50% improvement in NRS pain score at short-term follow-up (>1 week, <3 months post-injection).A chart review was performed of consecutive patients who underwent a thoracic TFESI over a 4- to 10-year time period at three academic spine centers and had reported an NRS pain score at short-term follow-up.Overall, 19/64 patients (30% [95% CI 20-42%]) experienced ≥50% relief following the injection at a median 22 days follow-up. 42% [95% CI 31-54%] experienced at least a 2-point improvement in NRS score. There was a slight improvement in median NRS scores from pre-to post-procedure of -1 (IQR -3, 0), from 6/10 to 5/10 (p ​< ​0.001). The success rate (≥50% pain relief) was 36% [95%CI 22-52%] in those with a disc herniation as compared to 21% [95%CI 10-40%]) in those with degenerative stenosis; however, the difference did not reach statistical significance. There was a trend towards a greater success rate in those who were employed vs. unemployed (43% [95% CI 27-61%] vs. 19% [95% CI 9-36%]).This is the largest series reporting outcomes from thoracic TFESI to date. Overall, the observed success rate was low compared to known success rates associated with TFESI for the treatment of pain at cervical and lumbar spinal regions.

  View details for DOI 10.1016/j.inpm.2021.100004

  View details for PubMedID 39301446

  View details for PubMedCentralID PMC11411569

• Reopening Interventional Pain Practices during the Early Phase of the COVID-19 Global Pandemic. Pain medicine (Malden, Mass.) Huynh, L., Chang, R. G., Chhatre, A., Sayeed, Y., MacVicar, J., McCormick, Z. L., Duszynski, B., Smith, C. 2021

  Abstract

  OBJECTIVE: Examine how interventional pain physicians navigated the early phase of reopening practices during the coronavirus disease 2019 (COVID-19) pandemic.METHODS: In June/July 2020, Spine Intervention Society members were queried about practice demographics, perception of COVID-19 prevalence, financial impact, and implementation of new tools and procedures when re-opening practices.RESULTS: Of the 2,295 members approached, 195 (8%) completed the survey. A majority (71%) reported using risk stratification tools and changing scheduling patterns. Nearly 70% performed initial assessments via telehealth and 87% for follow-up encounters. More than 80% performed symptom/temperature checks upon in-person clinic/facility entrance, and 63% screened patients via phone. Most (58%) did not test patients for COVID-19 for office visits, while 38% tested only if symptomatic. For epidural injections, intra-articular injections, and radiofrequency neurotomy procedures, 43% reported not testing patients, while 36% tested patients only if symptomatic. Most (70%) required patients to wear a mask upon entering the clinic/facility. For nonprocedure encounters, respondents used surgical masks (85%), gloves (35%), face shields/goggles (24%), N95 respirators (15%), and gowns (6%). Some (66%) discussed unique COVID-19 risks/complications and 26% provided written information. Most did not make changes to steroid dosage (67%) or peri-procedural anticoagulation management (97%). The vast majority (81%) estimated that COVID-19 will have a moderate-severe financial impact on their practice.CONCLUSIONS: COVID-19 has dramatically affected interventional pain practices with regard to telehealth, in-clinic precautions, screening/testing protocols, and patient counseling. Practice patterns will continue to evolve as we learn more about the disease and improve methods to provide safe and effective care.

  View details for DOI 10.1093/pm/pnab002

  View details for PubMedID 33624827

• The effect of patient satisfaction scores on physician job satisfaction and burnout FUTURE SCIENCE OA Schneider, B. J., Ehsanian, R., Schmidt, A., Huynh, L., Kennedy, D. J., Maher, D. P., Haring, S. 2020

  View details for DOI 10.2144/fsoa-2020-0136

  View details for Web of Science ID 000592116400001

• Conversion Disorder After a Lumbar Transforaminal Epidural Steroid Injection. PM & R : the journal of injury, function, and rehabilitation Tamura, L., Huynh, L. 2019

  View details for DOI 10.1002/pmrj.12204

  View details for PubMedID 31207138

• Pain and Functional Outcomes After Sacroiliac Joint Injection with Anesthetic and Corticosteroid at Six Months, Stratified by Anesthetic Response and Physical Exam Maneuvers. Pain medicine (Malden, Mass.) Schneider, B. J., Ehsanian, R. n., Huynh, L. n., Levin, J. n., Zheng, P. n., Kennedy, D. J. 2019

  Abstract

  To evaluate sacroiliac joint (SIJ) injection outcomes with local anesthetic and corticosteroid.Prospective cohort.Single academic medical center.Thirty-four patients referred for SIJ injection with a clinical diagnosis of SIJ pain underwent injections with 1:1 mixture of 2% lidocaine and triamcinolone 40 mg/mL. Pain provocation physical exam (PE) maneuvers were recorded immediately before and after injection. Outcome measures at two to four weeks and six months included pain numeric rating scale (NRS) and Oswestry Disability Index (ODI).For the analysis of outcomes by the overall group (not stratified by PE and/or anesthetic block), a 58.8% (95% confidence interval [CI] = +/-16.5%) ≥2 NRS reduction, a 32.4% (95% CI = +/-15.7%) ≥50% NRS reduction, and a 38.2% (95% CI = +/-16.3%) ≥30% ODI reduction were observed at two to four weeks, with similar improvements at six months. Outcomes stratified based on pre-injection PE did not reveal significant differences at either time point. The stratification based on the presence of 100% postinjection anesthetic response demonstrated a significant difference at two to four weeks for ≥50% NRS improvement. The true positive/true negative group (TP/TN) stratification demonstrated a significant difference for ≥50% NRS improvement at two to four weeks, whereas six-month outcomes for TP/TN demonstrated significant differences for ≥50% NRS and ≥30% ODI improvement. An increased injection response was observed with stratification of patients more likely to have true SIJ pain (i.e., TP), with TP/TN stratification demonstrating a 75% (95% CI = +/-30.0%) ≥2 NRS improvement and a 62.5% (95% CI = +/-33.5%) improvement of ≥50% NRS and ≥30% ODI for the TP group at two to four weeks, with similar results at six months.SIJ steroid injection based on referral clinical diagnosis is unlikely to demonstrate true injection efficacy, and more specific selection criteria are warranted.

  View details for DOI 10.1093/pm/pnz111

  View details for PubMedID 31106837

• Intra-articular Sacroiliac Joint Needle Placement: Ultrasound, Fluoroscopy, and the Criterion Standard. American journal of physical medicine & rehabilitation Schneider, B. J., Ehsanian, R. n., Levin, J. n., Huynh, L. n., Kennedy, D. J., McCormick, Z. L. 2019

  View details for DOI 10.1097/PHM.0000000000001288

  View details for PubMedID 31393271

• Validity of Physical Exam Maneuvers in the Diagnosis of Sacroiliac Joint Pathology. Pain medicine (Malden, Mass.) Schneider, B. J., Ehsanian, R. n., Rosati, R. n., Huynh, L. n., Levin, J. n., Kennedy, D. J. 2019

  Abstract

  A combination of physical examination maneuvers is currently considered necessary to help predict who will respond to injections in the sacroiliac joint. However, the literature on this topic currently consists of conflicting studies, with one showing the value of a combination of exam maneuvers and the other showing no real value.To determine the diagnostic validity of sacroiliac joint (SIJ) physical exam maneuvers using anesthetic intra-articular injection as a reference standard.A single institution prospective study.Patients with the clinical diagnosis of SIJ pain and referred for SIJ injection were enrolled.Numeric rating scale (NRS) to assess pain intensity.Participants underwent fluoroscopically guided SIJ intra-articular injection with 1 cc of 2% lidocaine and 1 cc of triamcinolone 40 mg. Patients' pain was assessed via 0-10 NRS pre-injection and immediately postinjection to determine positive anesthetic response to the injection. Six physical exam maneuvers (thigh thrust, Geanslen's test, FABER test, distraction test, compression test, and sacral thrust) were performed pre-injection and 15 minutes postinjection. The results of these SIJ physical exam maneuvers were evaluated singly and in combinations for diagnostic power in relation to a positive anesthetic response (>80% relief) to the injection. No association was found between a single SIJ physical exam maneuver or combination of maneuvers and anesthetic response to the injection.In this cohort, patient physical exam maneuvers to identify intra-articular SIJ pain did not demonstrate diagnostic value when compared with the reference standard of an intra-articular anesthetic block.

  View details for DOI 10.1093/pm/pnz183

  View details for PubMedID 31393577

• Intra-articular Steroids vs Saline for Lumbar Z-Joint Pain: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial. Pain medicine (Malden, Mass.) Kennedy, D. J., Fraiser, R., Zheng, P., Huynh, L., Levin, J., Smuck, M., Schneider, B. J. 2018

  Abstract

  Objective: To determine if intra-articular (IA) injection of corticosteroids is effective in reducing the need for radiofrequency ablation (RFA) in those with dual comparative medial branch block (MBB)-confirmed lumbar z-joint pain.Design: This was a randomized, double blind, placebo-controlled study.Setting: Two academic medical centers.Subjects: Fifty-six consecutive subjects who had ≥80% pain relief during an initial screening MBB were recruited.Methods: Patients received a second confirmatory MBB and concurrent IA injection of either corticosteroid or saline per randomization. Twenty-nine of 56 received intra-articular corticosteroid (triamcinolone 20mg), of whom 24 also had a positive confirmatory MBB per Spine Interventional Society guidelines, with ≥80% pain relief from both MBBs. Twenty-seven of 56 received IA saline into the z-joint during the confirmatory MBB, of whom 22 also had a positive confirmatory MBB. The primary outcome measure was the categorical need for RFA due to insufficient pain relief with intra-articular injection, and the secondary outcome was time to RFA.Results: There was no statistically significant difference in the need for an RFA between the groups (16/24 steroid, 67%, 95% confidence interval [CI]=47-82%) vs 15/22 saline (68%, 95% CI=47-84%, P=1.00). The average time to RFA was also not different, at 6.00weeks for steroids vs 6.55weeks for saline (P=0.82).Conclusions: Intra-articular corticosteroids were not effective in reducing the need for or the time to a radiofrequency ablation of the medial branches in those with dual MBB-confirmed lumbar z-joint pain.

  View details for PubMedID 30541041

• Corticosteroid Injections Into Lumbar Facet Joints: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION Kennedy, D. J., Huynh, L., Wong, J., Mattie, R., Levin, J., Smuck, M., Schneider, B. J. 2018; 97 (10): 741–46

  Abstract

  Corticosteroid injections into the intra-articular zygapophysial (z-joints) are frequently used to treat this cause of low back pain. No studies have been done on the efficacy of intra-articular corticosteroids in those with z-joint pain confirmed by dual comparative medial branch blocks.The aim of the study was to determine whether an injection of a corticosteroid into lumbar z-joints is effective in reducing pain and the need for radiofrequency neurotomy.This is a double-blind, prospective, randomized, placebo-controlled trial. The study was conducted in Academic Medical Center. Twenty-eight subjects with z-joint pain confirmed by medial branch blocks were included in the study. Subjects with confirmed z-joint pain via dual comparative medial branch block were randomized to receive either intra-articular corticosteroid (triamcinolone 20 mg) or saline via fluoroscopic guided injection.No statistically significant difference in the need for radiofrequency neurotomy (radiofrequency neurotomy) between the groups, with 75% (95% confidence interval = 50.5%-99.5%) of the saline group vs. 91% (95% confidence interval = 62.3%-100%) of the corticosteroid group receiving radiofrequency neurotomy. There is no difference in mean time to radiofrequency neurotomy between saline (6.1 wks) and corticosteroid (6.5 wks) groups. There is a need for radiofrequency neurotomy.Corticosteroid injections into the lumbar z-joints were not effective in reducing the need for radiofrequency neurotomy of the medial branches in those with z-joint pain confirmed by dual comparative medial branch blocks.

  View details for PubMedID 29734232

• A minimum of 5-year follow-up after lumbar transforaminal epidural steroid injections in patients with lumbar radicular pain due to intervertebral disc herniation. The spine journal : official journal of the North American Spine Society Kennedy, D. J., Zheng, P. Z., Smuck, M., McCormick, Z. L., Huynh, L., Schneider, B. J. 2017

  Abstract

  BACKGROUND CONTEXT: Patients with lumbosacral radiculopathy from an intervertebral disc herniation are frequently treated by transforaminal epidural steroid injections (TFESIs). The long-term outcomes of these patients are poorly described.PURPOSE: We aimed to determine the long-term outcomes for a homogenous group of patients with acute unilateral lumbar radicular pain due to single-level herniated nucleus after lumbar epidural steroid injection at ≥5 years.DESIGN: This is a prospective cohort study.PATIENT SAMPLE: Subjects enrolled into a previous reported multi-institutional randomized controlled trial, ≥18 years old with single leg radicular pain rating ≥4/10 for less than 6 months' duration, with radiographic imaging demonstrating an anatomically congruent single-level herniated nucleus pulposus.OUTCOME MEASURES: Presence of recurrent or persistent pain, pain within the previous week, current opioid use for radicular symptoms, additional spine injections for radicular pain, progression to surgery, and unemployment due to pain as determined by independent phone interview at least 5 years after enrolment due to the initial pain complaint were the outcome measures.METHODS: All patients initially underwent a single-level lumbar TFESIs due to failure of conservative care, but could elect to pursue surgical intervention or repeat injections through shared decision making with the treating physician when and if pain control was deemed inadequate. After ≥5 years, an independent assessor contacted the subjects by phone and performed a standardized interview to determine outcomes. Fisher exact test was used to compare outcomes for those who pursued versus those who did not pursue surgery.RESULTS: During the recruitment period (December 2008 to December 2012), 78 subjects were enrolled. At 5 years, 39 (50%) of the 78 subjects were reachable for independent phone follow-up. Of these, 30 (76.9%, 95% confidence interval [CI] 61.7%-87.4%) had a history of recurrent pain since the initial TFESI. However, only 9 (23.1%, 95% CI 12.7%-38.3%) had current pain, while 3 (7.7%, 95% CI 2.7%-20.3%) were currently taking opioid medications. Nine (23.1%, 95% CI 12.7%-38.3%) had received additional TFESIs, and 19 (48.7%, 95% CI 33.9%-63.8%) had received surgery. Only 3 (7.7%, 95% CI 2.7%-20.3%) were unemployed due to related pain at time of follow-up. When comparing the group that had surgery versus those that did not, there were no differences in the rates of recurrent pain (16, 84.2% vs. 14, 70.0%, p=.81), current pain (6, 31.6% vs. 3, 15.0%, p=.47), opioid use (2, 10.5% vs. 1, 5.0%, p=1.00), rate of additional injections (6, 31.6% vs. 3, 15.0%, p=.47), or unemployment status (2, 10.5% vs. 1, 5.0%, p=1.00).CONCLUSIONS: Despite a high success rate at 6 months, the majority of subjects experienced a recurrence of symptoms at some time during the subsequent 5 years. Fortunately, few reported current symptoms, and a small minority required additional injections, surgery, or opioid pain medications. Lumbar disc herniation is a disease that can be effectively treated in the short-term by TFESI or surgery, but long-term recurrence rates are high regardless of treatment received.

  View details for PubMedID 28962912

• Does Immediate Pain Relief After an Injection into the Sacroiliac Joint with Anesthetic and Corticosteroid Predict Subsequent Pain Relief? Pain medicine (Malden, Mass.) Schneider, B. J., Huynh, L., Levin, J., Rinkaekan, P., Kordi, R., Kennedy, D. J. 2017

  Abstract

  To determine if immediate pain response following an injection with local anesthetic and corticosteroid predicts subsequent relief. Prospective observational cohort. An institutional review board-approved prospective study from a single academic medical center. Patients with clinical diagnosis of sacroiliac (SIJ) pain and referred for SIJ injection were enrolled; 1 cc of 2% lidocaine and 1 cc of triamcinolone 40 mg/mL were injected into the SIJ. Pain score on 0-10 numeric rating scale (NRS) during provocation maneuvers was recorded immediately before injection, immediately after injection, and at two and four weeks of follow-up. Oswestry Disability Index (ODI) was also recorded. Various cutoffs were identified to establish positive anesthetic response and successful outcomes at follow-up. These were used to calculated likelihood ratios. Of those with 100% anesthetic response, six of 11 (54.5%, 95% confidence interval [CI]+/-29.4%, +LR 2.6, 95% CI = 1.1-5.9) demonstrated 50% or greater pain relief at follow-up, and four of 11 (36.5%, 95% CI+/-28.4%, +LR 3.00, 95% CI = 1.4-5.1) had 100% relief at two to four weeks. Fourteen of 14 (100%, 95% CI+/-21.5%, -LR 0.0, 95% CI = 0.0-2.1) with an initial negative block failed to achieve 100% relief at follow-up. Patients who fail to achieve initial relief after SIJ injection with anesthetic and steroid are very unlikely to achieve significant pain relief at follow-up; negative likelihood ratios (LR) in this study, based on how success is defined, range between 0 and 0.9. Clinically significant positive likelihood ratios of anesthetic response to SIJ injection are more limited and less robust, but are valuable in predicting 50% relief or 100% relief at two to four weeks.

  View details for DOI 10.1093/pm/pnx104

  View details for PubMedID 28521006

• Ideal cervical epidural injection route: interlaminar or transforaminal Curr Phys Med Rehabil Rep Huynh, L., Smuck, M. 2015; 3 (2): 142-150
• Does FAC predict response to epidural steroid injection Pain Med Huynh, L., Smuck, M., Martinez-Ith, A., Kennedy, D. J. 2014; 15: 1438-1439
• Low Back Pain in Athletes ACSM Health and Fitness Journal Huynh, L., Chimes, G. P. 2014; 18: 15-22