Epidural steroid injections for pain management in spinal metastases: clinical predictors of effectiveness in a retrospective cohort study.

BACKGROUND

Cancer-related pain management remains challenging, particularly for spinal metastases, in which pain arises from multiple pathological mechanisms. Despite the increasing use of epidural steroid injections (ESI) in clinical practice as part of multimodal pain management, the evidence of their effectiveness in these patients remains limited.

DESIGN

A retrospective cohort study.

SETTING

Three university-affiliated tertiary hospitals in South Korea.

SUBJECTS: A total of 123 patients with cancer and radiologically confirmed spinal metastases who underwent ESI between January 2020 and December 2022. Patients were categorized as effective (Group E, ≥50% pain reduction at 1 month, n = 73) or non-effective (Group N, n = 50).

METHODS

Pain intensity, opioid use, patient satisfaction, repeat procedures, and survival were evaluated at baseline and 1 and 3 months after ESI. In addition, factors influencing the effectiveness of ESI were analyzed.

RESULTS

A better performance status (ECOG-PS 1) and lower baseline opioid requirements predicted a favorable ESI response. The Group E maintained pain relief at 3 months with a minimal increase in opioid use, reported higher satisfaction (94.5% vs 6.5%), needed fewer repeat injections (64.4% vs 86.6%), and demonstrated better 6-month survival (78.1% vs 34.0%) than Group N.

CONCLUSION

ESI may be beneficial in reducing pain and attenuating opioid escalation in patients with spinal metastases, especially when the performance status is relatively preserved, and before the initiation of high-dose opioid therapy. These results support early integration of ESI into multimodal cancer pain management strategies.