959 - Higher Pain and Worse Maladaptive Pain Beliefs in Non-specific cLBP Patients Who Pursued Spinal Injections as Compared to Only Conservative Care

Previous spinal injection studies have overlooked key patient aspects like pain interference, mood, and pain beliefs in those who pursue injections. These patient characteristics, especially maladaptive pain beliefs, may influence patients to pursue injections and predispose them to worse outcomes after interventions. This study aims to fill this gap by comparing these factors in patients opting for injections versus choosing conservative care, defined as avoiding injections or surgeries.


Design:

Subanalysis of baseline data from an online cohort of 1376 cLBP patients across the United States. Numerical rating scale (NRS) over the last 7 days; Pain, Enjoyment of Life, and General Activity (PEG) Scale; PROMIS depression 4a; PROMIS anxiety 4a; Fear Avoidance Beliefs Questionnaire – physical activity subscore and Pain Catastrophizing Scale SF were measured and summarized at baseline as well as basic demographic information. T-tests and chi-square tests were used to compare conservative versus injection participant characteristics.


Results:

859 reported undergoing only conservative care with 327 pursuing injections. Participants who pursued injections were more likely to have worse pain NRS (5.2 ± 1.9 v 4.5 ± 1.8; P< 0.01) and higher PEG scores (5.0 ± 2.2 v 4.0 ± 2.1; P< 0.01). The injection group displayed more fear avoidance (12.3 ± 5.9 v 11.1 ± 5.8; P=0.01) though there were not significantly higher mean pain catastrophizing scores. Depression and anxiety scores were comparable.

Conclusions:

Participants with non-specific cLBP who pursued spinal injections exhibited more pain and fear avoidance than those choosing conservative care. Higher rates of maladaptive pain beliefs may have contributed to increased pain and healthcare utilization. Notably, increased fear-avoidance has been associated with poorer intervention outcomes for back pain. Study limitations include recall and reporting bias associated with survey-based studies. Future research should explore pain belief characteristics in patients who pursue injections and their predictive value in treatment response.