<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04451252</url>
  </required_header>
  <id_info>
    <org_study_id>PRETI-DOL-V1</org_study_id>
    <nct_id>NCT04451252</nct_id>
  </id_info>
  <brief_title>Predicting Response to Interventional Pain Management Techniques in Chronic Low Back Pain in a Prospective Cohort.</brief_title>
  <acronym>PReTI-Back</acronym>
  <official_title>Observational Prospective Single Centre Study of the Response to Interventional Pain Management Techniques in Chronic Low Back Pain in Adults. 1 and 6 Months Follow-up. Multivariate Analysis of Predictors of Response. Predictive Model.</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Santiago Garcia-Hernandez</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Hospital General Universitario Gregorio Marañon</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      The main aim of this study is to identify factors that may be associated with a better or&#xD;
      worse response to interventional pain management therapies for the treatment of chronic&#xD;
      lumbar pain in adult patients. If several predictive factors are to be identified, a&#xD;
      predictive model will be developed.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Chronic lumbar pain is a common affection in the adult population, and an important source of&#xD;
      chronic incapacity and impaired quality of life. There is a wide range of therapeutic options&#xD;
      for the treatment of chronic lumbar pain. This study will analyze the response to several&#xD;
      interventional pain management techniques and will search for factors that may be associated&#xD;
      to a better or worse response to the techniques.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Unknown status</overall_status>
  <last_known_status>Active, not recruiting</last_known_status>
  <start_date type="Actual">October 2, 2019</start_date>
  <completion_date type="Anticipated">November 30, 2022</completion_date>
  <primary_completion_date type="Anticipated">May 31, 2022</primary_completion_date>
  <study_type>Observational</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Other</observational_model>
    <time_perspective>Prospective</time_perspective>
  </study_design_info>
  <primary_outcome>
    <measure>Clinical response to IPMT after 4 weeks follow-up after the IPMT is performed (composite outcome)</measure>
    <time_frame>Baseline (prior to the Interventional Pain Management Therapy); Week 4 after IPMT</time_frame>
    <description>Clinical response after 4 week follow-up is going to be defined as composite outcomes:&#xD;
Positive strong response (PSR-4W): a positive strong response to the interventional pain management therapy after 4 weeks follow-up is defined as a composite outcome. Patients must meet both the following criteria:&#xD;
A decrease in Numeric Rating Scale of at least 3 points.&#xD;
A decrease in the Oswestry Disability Index of al least 40%.&#xD;
Positive moderate response (PMR-4W): a positive moderate response to the interventional pain management therapy after 4 weeks follow-up is defined as a composite outcome. Patients must meet both the following criteria:&#xD;
A decrease in Numeric Rating Scale of at least 2 points.&#xD;
A decrease in the Oswestry Disability Index of al least 20%.&#xD;
No response (NR-4W): no response to IPMT after 4 weeks follow-up is defined as those patients not included in either of the previous categories.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Factors that may be associated with no response to the IPMT at 4 weeks follow-up.</measure>
    <time_frame>Response will be measured after 4 weeks follow-up after the IPMT.</time_frame>
    <description>14 candidate variables will be analyzed for association to no response to the IPMT at 4 weeks (NR-4W). All the variables are qualitative, dichotomic, yes/no:&#xD;
Work sick leave.&#xD;
Depression/Anxiety.&#xD;
Obesity.&#xD;
Existence of another chronic pain.&#xD;
Failed back surgery syndrome.&#xD;
Radicular compression in imaging.&#xD;
Herniated disc in imaging.&#xD;
Radiate pain.&#xD;
Age: older than 65 years old (&gt;65 years old).&#xD;
Chronic therapy with opioid medication.&#xD;
Chronic therapy with gabapentionids.&#xD;
Chronic therapy with opioid medication AND gabapentinoids.&#xD;
Clinical Frailty Scale &gt;3 (≥4).&#xD;
Initial Oswestry Disability Index ≥40.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Factors that may be associated with a positive response to the IPMT (PSR-4W or PMR-4W).</measure>
    <time_frame>Response will be measured after 4 weeks follow-up.</time_frame>
    <description>14 candidate variables will be analyzed for association to PSR-4W or PMR-4W to the IPMT at 4 weeks. All the variables are qualitative, dichotomic, yes/no:&#xD;
Working.&#xD;
Depression/Anxiety.&#xD;
Obesity.&#xD;
Failed back surgery syndrome.&#xD;
Radicular compression in imaging.&#xD;
Herniated disc in imaging.&#xD;
Radiate pain.&#xD;
Age: younger than 45 years old (&lt;45 years old).&#xD;
Chronic therapy with opioid medication.&#xD;
Chronic therapy with gabapentinoids medication.&#xD;
Chronic therapy with opioid medication AND gabapentinoids.&#xD;
Clinical Frailty Scale &lt;3.&#xD;
Initial Oswestry Disability Index ≥40.&#xD;
Subjective good subjective result in previous performed interventional pain management therapies.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Clinical response to IPMT after 24 weeks follow-up after the IPMT is performed (composite outcome).</measure>
    <time_frame>Response will be measured after 24 weeks follow-up after the IPMT.</time_frame>
    <description>Clinical response after 24 week follow-up is going to be defined as composite outcomes:&#xD;
Positive strong response (PSR-24W): a positive strong response to the interventional pain management therapy after 24 weeks follow-up is defined as a composite outcome. Patients must meet both the following criteria:&#xD;
A decrease in Numeric Rating Scale of at least 3 points.&#xD;
A decrease in the Oswestry Disability Index of al least 40%.&#xD;
Positive moderate response (PMR-24W): a positive moderate response to the interventional pain management therapy after 24 weeks follow-up is defined as a composite outcome. Patients must meet both the following criteria:&#xD;
A decrease in Numeric Rating Scale of at least 2 points.&#xD;
A decrease in the Oswestry Disability Index of al least 20%.&#xD;
No response (NR-24W): no response to IPMT after 24 weeks follow-up is defined as those patients not included in either of the previous categories.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Factors that may be associated with no response to the IPMT at 24 weeks follow-up.</measure>
    <time_frame>The factors will be recorded at baseline; the response will be measured at after 24 weeks follow-up.</time_frame>
    <description>14 candidate variables will be analyzed for association to no response to the IPMT at 24 weeks (NR-24W). All the variables are qualitative, dichotomic, yes/no:&#xD;
Work sick leave.&#xD;
Depression/Anxiety.&#xD;
Obesity.&#xD;
Existence of another chronic pain.&#xD;
Failed back surgery syndrome.&#xD;
Radicular compression in imaging.&#xD;
Herniated disc in imaging.&#xD;
Radiate pain.&#xD;
Age: older than 65 years old (&gt;65 years old).&#xD;
Chronic therapy with opioid medication.&#xD;
Chronic therapy with gabapentinoids medication.&#xD;
Chronic therapy with opioid medication AND gabapentinoids.&#xD;
Clinical Frailty Scale &gt;3 (≥4).&#xD;
Initial Oswestry Disability Index ≥40.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Factors that may be associated with a positive response to the IPMT after a 24 weeks follow-up (PSR-24W or PMR-24W).</measure>
    <time_frame>Response will be measured after 24 weeks follow-up after the IPMT.</time_frame>
    <description>14 candidate variables will be analyzed for association to PSR-4W or PMR-4W to the IPMT at 24 weeks. All the variables are qualitative, dichotomic, yes/no:&#xD;
Working.&#xD;
Depression/Anxiety.&#xD;
Obesity.&#xD;
Failed back surgery syndrome.&#xD;
Radicular compression in imaging.&#xD;
Herniated disc in imaging.&#xD;
Radiate pain.&#xD;
Age: younger than 45 years old (&lt;45 years old).&#xD;
Chronic therapy with opioid medication.&#xD;
Chronic therapy with gabapentinoids medication.&#xD;
Chronic therapy with opioid medication AND gabapentinoids.&#xD;
Clinical Frailty Scale &lt;3.&#xD;
Initial Oswestry Disability Index ≥40.&#xD;
Good subjective result in previous performed interventional pain management therapies.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Validation a predictive model for positive response to the IPMT after 4 weeks</measure>
    <time_frame>Response will be measured after 4 weeks follow-up after the IPMT.</time_frame>
    <description>In case that several predictive variables are identified, a predictive model will be developed, either for predicting good and/or bad response.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Validation a predictive model for positive response to the IPMT after 24 weeks</measure>
    <time_frame>Response will be measured after 24 weeks follow-up after the IPMT.</time_frame>
    <description>In case that several predictive variables are identified, a predictive model will be developed, either for predicting good and/or bad response.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Identifying other variables that may be associated with a good or bad response to an interventional pain management therapy (IPMT) at 4 weeks</measure>
    <time_frame>Response will be measured after 4 weeks follow-up after the IPMT</time_frame>
    <description>Other variables recorded in the Data Collection Logbook of our study will be analyzed looking for other associations:&#xD;
Fibromyalgia.&#xD;
Depression, anxiety and/or mixed axiety-depressive disorder.&#xD;
Obesity.&#xD;
Other chronic pain.&#xD;
Failed back surgery syndrome.&#xD;
Osteoporotic fracture.&#xD;
Lumbar canal stenosis syndrome.&#xD;
Irradiated pain to leg.&#xD;
Diabetes Mellitus.&#xD;
Arthrosis.&#xD;
Inflammatory arthritis.&#xD;
Oncologic condition.&#xD;
Osteoporosis.&#xD;
Substance abuse disorder.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Identifying other variables that may be associated with a good or bad response to an interventional pain management therapy (IPMT) at 24 weeks</measure>
    <time_frame>Response will be measured after 24 weeks follow-up after the IPMT</time_frame>
    <description>Other variables recorded in the Data Collection Logbook of our study will be analyzed looking for other associations:&#xD;
Fibromyalgia.&#xD;
Depression, anxiety and/or mixed axiety-depressive disorder.&#xD;
Obesity.&#xD;
Other chronic pain.&#xD;
Failed back surgery syndrome.&#xD;
Osteoporotic fracture.&#xD;
Lumbar canal stenosis syndrome.&#xD;
Irradiated pain to leg.&#xD;
Diabetes Mellitus.&#xD;
Arthrosis.&#xD;
Inflammatory arthritis.&#xD;
Oncologic condition.&#xD;
Osteoporosis.&#xD;
Substance abuse disorder.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Analyzing the response after 4 weeks to therapy of each interventional pain management therapy alone, and which variables may be associated with a better response to therapy.</measure>
    <time_frame>Response will be measured after 4 weeks follow-up after the IPMT</time_frame>
    <description>The therapies that will be analyzed are:&#xD;
Fluoroscopically guided lumbar medial branch nerve radiofrequency denervation.&#xD;
Fluoroscopically guided lumbar facet joint injection.&#xD;
Fluoroscopically guided lumbar epidural corticosteroid injection.&#xD;
Fluoroscopically guided caudal epidural corticosteroid injection.&#xD;
Fluoroscopically guided pulsed radiofrequency of the lumbar dorsal root ganglion.&#xD;
Fluoroscopically guided transforaminal epidural corticosteroid injection or lumbar selective root block.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Analyzing the response after 24 weeks to therapy of each interventional pain management therapy alone, and which variables may be associated with a better response to therapy.</measure>
    <time_frame>Response will be measured after 24 weeks follow-up after the IPMT</time_frame>
    <description>The therapies that will be analyzed are:&#xD;
Fluoroscopically guided lumbar medial branch nerve radiofrequency denervation.&#xD;
Fluoroscopically guided lumbar facet joint injection.&#xD;
Fluoroscopically guided lumbar epidural corticosteroid injection.&#xD;
Fluoroscopically guided caudal epidural corticosteroid injection.&#xD;
Fluoroscopically guided pulsed radiofrequency of the lumbar dorsal root ganglion.&#xD;
Fluoroscopically guided transforaminal epidural corticosteroid injection or lumbar selective root block.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Studying the association between main clinical diagnosis and the response to therapy, globally and stratified by single IPMT, after 4 weeks of the IPMT</measure>
    <time_frame>Response will be measured after 4 weeks follow-up after the IPMT</time_frame>
    <description>Main clinical diagnosis, response to therapy and IPMT performed are described separately as outcomes.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Studying the association between main clinical diagnosis and the response to therapy, globally and stratified by single IPMT, after 24 weeks of the IPMT</measure>
    <time_frame>Response will be measured after 24 weeks follow-up after the IPMT</time_frame>
    <description>Main clinical diagnosis, response to therapy and IPMT performed are described separately as outcomes.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Studying the satisfaction of the patients to the IPMT performed, after 24 weeks of IPMT</measure>
    <time_frame>Satisfaction will be measured after 24 weeks follow-up after the IPMT</time_frame>
    <description>Patient satisfaction will be assessed as two separate YES/NO questions:&#xD;
Are you satisfied with the pain-relief obtained after you underwent the Interventional Pain Management Technique? (YES/NO answer).&#xD;
Based on your experience, would you undergo the same treatment again? (YES/NO answer).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Studying the satisfaction of the patients to the IPMT performed, after 4 weeks of IPMT</measure>
    <time_frame>Satisfaction will be measured after 4 weeks follow-up after the IPMT</time_frame>
    <description>Patient satisfaction will be assessed as two separate YES/NO questions:&#xD;
- Are you satisfied with the pain-relief obtained after you underwent the Interventional Pain Management Technique? (YES/NO answer).&#xD;
Patient satisfaction will be assessed as two separate YES/NO questions:&#xD;
Are you satisfied with the pain-relief obtained after you underwent the Interventional Pain Management Technique? (YES/NO answer).&#xD;
Based on your experience, would you undergo the same treatment again? (YES/NO answer).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Studying the correlation of both scales (Numeric Rating Scale and Oswestry Disability Index) and patient satisfaction after 4 weeks of the IPMT</measure>
    <time_frame>Response and satisfaction will be measured after 4 weeks follow-up after the IPMT</time_frame>
    <description>Patient satisfaction will be assessed as two separate YES/NO questions:&#xD;
Are you satisfied with the pain-relief obtained after you underwent the Interventional Pain Management Technique? (YES/NO answer).&#xD;
Based on your experience, would you undergo the same treatment again? (YES/NO answer).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Studying the correlation of both scales (Numeric Rating Scale and Oswestry Disability Index) and patient satisfaction after 24 weeks of the IPMT</measure>
    <time_frame>Response and satisfaction will be measured after 24 weeks follow-up after the IPMT</time_frame>
    <description>Patient satisfaction will be assessed as two separate YES/NO questions:&#xD;
Are you satisfied with the pain-relief obtained after you underwent the Interventional Pain Management Technique? (YES/NO answer).&#xD;
Based on your experience, would you undergo the same treatment again? (YES/NO answer).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Studying the epidemiology and evolution of the pharmacological therapy of our population (Part I)</measure>
    <time_frame>Drug therapy will be recorded at baseline</time_frame>
    <description>Variable #1. Qualitative; is the patient taking any of the following medications (YES/NO for each treatment) at visit 0?:&#xD;
Acetanomiphen.&#xD;
Metamizole.&#xD;
NSAID #1 (specify which).&#xD;
NSAID #1 (specify which).&#xD;
Gabapentine.&#xD;
Pregabaline.&#xD;
Tramadol.&#xD;
Tapentadol.&#xD;
Oxicodone.&#xD;
Metadone.&#xD;
Transdermic Fentanyl.&#xD;
Transdermic Buprenorphine.&#xD;
Amitriptiline.&#xD;
Desipramine.&#xD;
Nortriptiline.&#xD;
Duloxetine.&#xD;
Desvenlafaxine.&#xD;
Paroxetine.&#xD;
Citalopram.&#xD;
Transdermic lidocaine.&#xD;
Transdermic capsaicine.&#xD;
Benzodiacepine (specify which).&#xD;
Dexametasone.&#xD;
Prednisone.&#xD;
Hidrocodone.&#xD;
Hidromorphone.&#xD;
Oximorphine.&#xD;
Minalcipram.&#xD;
Bupropion.&#xD;
Valproate.&#xD;
Carbamazepine.&#xD;
Lamotrigine.&#xD;
Other (1) (specify which).&#xD;
Other (2) (specify which).&#xD;
Other (3) (specify which).&#xD;
Variable #2. Quantitative. 24 hour dose of each pharmacologic treatment the patient is taking at visit 0.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Studying the epidemiology and evolution of the pharmacological therapy of our population (Part II)</measure>
    <time_frame>Drug therapy will be recorded at baseline; change in therapy will be recorded vs 4 weeks and vs 24 weeks.</time_frame>
    <description>Variable #3. Qualitative. Is the patient taking any pharmacological treatment belonging to any of the following cathegories?:&#xD;
NSAIDs, acetanomiphen, metamizole.&#xD;
Opioids.&#xD;
Oral opioids.&#xD;
Minor opioids (tramadol, tapendatol, codeine)&#xD;
Strong opioids.&#xD;
Transdermic opioids.&#xD;
Gabapentinoids.&#xD;
Antidepressants.&#xD;
Benzodiazepines.&#xD;
Anticonvulsivants.&#xD;
Variable #4. Qualitative. Has it been any change in pharmacological treatment in the follow-up (baseline vs 4 weeks and vs 24 weeks) ; related to each pharmacological treatment)?:&#xD;
Unchanged.&#xD;
Higher dose.&#xD;
Lower dose.&#xD;
Treatment stopped.&#xD;
Variable #5. Qualitative. Why was the pharmacological treatment changed (baseline vs 4 weeks and vs 24 weeks) ?:&#xD;
Clinical improvement.&#xD;
Secondary effects.&#xD;
Change for another pharmacological treatment.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Studying the safety and potential adverse reactions to IPMT.</measure>
    <time_frame>Potential adverse reactions will be measured at the end of follow-up (after 24 weeks of the IPMT)</time_frame>
    <description>Several cathegories:&#xD;
Postdural puncture headache.&#xD;
Infectious complication.&#xD;
Epidural hematoma.&#xD;
Neurologic damage.&#xD;
Other (specify).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Studying the epidemiology of radiological findings in our population, and its association with the IPMT performed and the response to therapy after 4 weeks.</measure>
    <time_frame>Response will be measured after 4 weeks follow-up after the IPMT</time_frame>
    <description>Several cathegories or radiological findings:&#xD;
Discopathy.&#xD;
Herniated disk.&#xD;
Central stenosis.&#xD;
Lateral stenosis.&#xD;
Radicular compression.&#xD;
Spondyloarthrosis.&#xD;
Spondylolisthesis.&#xD;
Epidural fibrosis.&#xD;
Reumatic inflammatory disease.&#xD;
Vertebral compression fracture.&#xD;
Scoliosis.&#xD;
Other (specify).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Studying the epidemiology of radiological findings in our population, and its association with the IPMT performed and the response to therapy after 24 weeks.</measure>
    <time_frame>Response will be measured after 24 weeks follow-up after the IPMT</time_frame>
    <description>Several cathegories or radiological findings:&#xD;
Discopathy.&#xD;
Herniated disk.&#xD;
Central stenosis.&#xD;
Lateral stenosis.&#xD;
Radicular compression.&#xD;
Spondyloarthrosis.&#xD;
Spondylolisthesis.&#xD;
Epidural fibrosis.&#xD;
Reumatic inflammatory disease.&#xD;
Vertebral compression fracture.&#xD;
Scoliosis.&#xD;
Other (specify).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Studying the epidemiology of radiological findings in our population, and its association with clinical findings and clinical diagnosis.</measure>
    <time_frame>Response will be measured after 24 weeks follow-up after the IPMT</time_frame>
    <description>Several cathegories:&#xD;
Discopathy.&#xD;
Herniated disk.&#xD;
Central stenosis.&#xD;
Lateral stenosis.&#xD;
Radicular compression.&#xD;
Spondyloarthrosis.&#xD;
Spondylolisthesis.&#xD;
Epidural fibrosis.&#xD;
Reumatic inflammatory disease.&#xD;
Vertebral compression fracture.&#xD;
Scoliosis.&#xD;
Other (specify).&#xD;
Clinical findings are:&#xD;
Fibromyalgia.&#xD;
Failed back surgery syndrome.&#xD;
Osteoporotic fracture.&#xD;
Lumbar canal stenosis syndrome.&#xD;
Irradiated pain to leg.&#xD;
Arthrosis.&#xD;
Inflammatory arthritis.&#xD;
Oncologic condition.&#xD;
Osteoporosis.&#xD;
Clinical diagnosis are defined as another outcome measure.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Analyzing the epidemiology of comorbidities (pain and not pain related) in our population:</measure>
    <time_frame>Comorbidites will be recorded at baseline</time_frame>
    <description>Comorbities that will be analyzed are:&#xD;
Fibromyalgia.&#xD;
Depression, anxiety and/or mixed axiety-depressive disorder.&#xD;
Obesity.&#xD;
Other chronic pain.&#xD;
Failed back surgery syndrome.&#xD;
Osteoporotic fracture.&#xD;
Lumbar canal stenosis syndrome.&#xD;
Irradiated pain to leg.&#xD;
Diabetes Mellitus.&#xD;
Arthrosis.&#xD;
Inflammatory arthritis.&#xD;
Oncologic condition.&#xD;
Osteoporosis.&#xD;
Substance abuse disorder.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Analyzing the demographical data of the study population.</measure>
    <time_frame>Demographical data will be obtained at baseline</time_frame>
    <description>Age, sex, marital status, working status at ethnic group and Medical Specialty that derivated the patient to our unit will be recorded at base line.&#xD;
Working status: It will classified as: &quot;active worker&quot;, &quot;work sick leave&quot;, &quot;studying&quot;, &quot;retired person&quot;, &quot;incapacitated to work&quot; and &quot;convict&quot;&#xD;
Marital status: It will classified as: &quot;single&quot;, &quot;unmarried partner&quot;, &quot;married&quot;, &quot;divorced&quot; and &quot;widowed&quot;.&#xD;
Ethnic group: It will be classified as: &quot;caucasic&quot;, &quot;african&quot;; &quot;latin&quot;, &quot;asiatic&quot;, &quot;romany&quot; and &quot;other&quot;.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Studying the evolution in time of the response to the IPMT.</measure>
    <time_frame>the response will be measured at +4weeks, +8weeks and +24 weeks</time_frame>
    <description>Positive strong response, both strong (PSR) and moderate (PMR), as defined in &quot;Primary outcomes&quot; will be measured both at baseline vs 4 weeks follow-up, baseline vs 24 weeks follow-up and baseline vs 8 weeks follow-up.&#xD;
The evolution of the pain response will be studied; response and satisfaction will be measured at 4 different moments:&#xD;
Baseline (prior to the performance of the IPMT).&#xD;
4 weeks after the IPMT is performed.&#xD;
8 weeks after the IPMT is performed.&#xD;
24 weeks after the IPMT is performed.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Charlson comorbidity index</measure>
    <time_frame>Calculated at baseline</time_frame>
    <description>Charlson comorbidity index will be calculated at baseline.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Pain syndrome</measure>
    <time_frame>Pain syndrome is diagnosed at baseline</time_frame>
    <description>Variable 1: presence of any of the following diagnosis:&#xD;
Facet joint syndrome.&#xD;
Vertebral crush fracture.&#xD;
Discogenic pain.&#xD;
Lateral lumbar canal stenosis.&#xD;
Sacroiliac pain syndrome.&#xD;
Central lumbar canal stenosis.&#xD;
Failed back surgery syndrome.&#xD;
None of the previous diagnosis. Variable n 2. Main pain syndrome, which is the one that motivates the IPMT.&#xD;
Facet joint syndrome.&#xD;
Vertebral crush fracture.&#xD;
Discogenic pain.&#xD;
Lateral lumbar canal stenosis.&#xD;
Sacroiliac pain syndrome.&#xD;
Central lumbar canal stenosis.&#xD;
Failed back surgery syndrome.&#xD;
None of the previous diagnosis.&#xD;
There is no main pain syndrome: the patient has multiple pain diagnosis, and no single one prevails among the others. The IPMT is under a mixed therapeutic and diagnostic approach.&#xD;
Variable n3: number of pain syndromes present in the patient, of all the above.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Main operator of the IPMT</measure>
    <time_frame>Measured 4 weeks after IPMT is performed</time_frame>
    <description>Two cathegories:&#xD;
Attending Pain Physician.&#xD;
Anestesiology Resident.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Previous treatments, and success</measure>
    <time_frame>Measured at baseline</time_frame>
    <description>Variables n1 and n 2 are qualitative. Measured at visit 0.&#xD;
Variable n 1: the patient has undergone any of these treatments:&#xD;
Back surgery.&#xD;
Previous IPMT.&#xD;
No IPMT.&#xD;
Variable n 2: subjective satisfaction of the patient:&#xD;
Satisfied.&#xD;
Not satisfied.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Numeric Rating Scale of pain at baseline</measure>
    <time_frame>baseline</time_frame>
    <description>The 11-point numerical pain rating scale (NRS) is a measure of pain in which patients rate their pain ranging from 0 (no pain) to 10 (worst imaginable pain). Validated in Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30:1331-4.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Numeric Rating Scale of pain at 4 weeks after the IPMT is performed</measure>
    <time_frame>4 weeks after the IPMT is performed</time_frame>
    <description>The 11-point numerical pain rating scale (NRS) is a measure of pain in which patients rate their pain ranging from 0 (no pain) to 10 (worst imaginable pain). Validated in Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30:1331-4.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Numeric Rating Scale of pain at 8 weeks after the IPMT is performed</measure>
    <time_frame>8 weeks after the IPMT is performed</time_frame>
    <description>The 11-point numerical pain rating scale (NRS) is a measure of pain in which patients rate their pain ranging from 0 (no pain) to 10 (worst imaginable pain). Validated in Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30:1331-4.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Numeric Rating Scale of pain at 24 weeks after the IPMT is performed</measure>
    <time_frame>24 weeks after the IPMT is performed</time_frame>
    <description>The 11-point numerical pain rating scale (NRS) is a measure of pain in which patients rate their pain ranging from 0 (no pain) to 10 (worst imaginable pain). Validated in Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30:1331-4.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Oswestry Disability Index at baseline</measure>
    <time_frame>baseline</time_frame>
    <description>Original version 1 (1980), translated and adapted to Spanish (1995), validated.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Oswestry Disability Index at 4 weeks after the IPMT is performed</measure>
    <time_frame>4 weeks after the IPMT is performed</time_frame>
    <description>Original version 1 (1980), translated and adapted to Spanish (1995), validated.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Oswestry Disability Index at 8 weeks after the IPMT is performed</measure>
    <time_frame>8 weeks after the IPMT is performed</time_frame>
    <description>Original version 1 (1980), translated and adapted to Spanish (1995), validated.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Oswestry Disability Index at 24 weeks after the IPMT is performed</measure>
    <time_frame>24 weeks after the IPMT is performed</time_frame>
    <description>Original version 1 (1980), translated and adapted to Spanish (1995), validated.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Clinical Frailty Scale at baseline</measure>
    <time_frame>Obtained at baseline</time_frame>
    <description>As described by Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173:489-95.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Previous treatments, and success</measure>
    <time_frame>Mesured at baseline</time_frame>
    <description>Variables n1 and n 2 are qualitative. Measured at visit 0.&#xD;
Variable n 1: the patient has undergone any of these treatments:&#xD;
Back surgery.&#xD;
Previous IPMT.&#xD;
No IPMT.&#xD;
Variable n 2: subjective satisfaction of the patient:&#xD;
Satisfied.&#xD;
Not satisfied.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Interventional Pain Management Technique indicated at visit 0.</measure>
    <time_frame>Baseline</time_frame>
    <description>Several cathegories:&#xD;
Fluoroscopically guided lumbar medial branch nerve radiofrequency denervation.&#xD;
Fluoroscopically guided lumbar facet joint injection.&#xD;
Fluoroscopically guided lumbar epidural corticosteroid injection.&#xD;
Fluoroscopically guided caudal epidural corticosteroid injection.&#xD;
Fluoroscopically guided pulsed radiofrequency of the lumbar dorsal root ganglion.&#xD;
Fluoroscopically guided transforaminal epidural corticosteroid injection or lumbar selective root block.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Interventional Pain Management Technique performed.</measure>
    <time_frame>Measured 4 weeks after the IPMT</time_frame>
    <description>Several cathegories:&#xD;
Fluoroscopically guided lumbar medial branch nerve radiofrequency denervation.&#xD;
Fluoroscopically guided lumbar facet joint injection.&#xD;
Fluoroscopically guided lumbar epidural corticosteroid injection.&#xD;
Fluoroscopically guided caudal epidural corticosteroid injection.&#xD;
Fluoroscopically guided pulsed radiofrequency of the lumbar dorsal root ganglion.&#xD;
Fluoroscopically guided transforaminal epidural corticosteroid injection or lumbar selective root block.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Imaging modality</measure>
    <time_frame>Baseline</time_frame>
    <description>Qualitative:&#xD;
MRI.&#xD;
ST scan.&#xD;
Lumbar x-ray.</description>
  </secondary_outcome>
  <enrollment type="Anticipated">500</enrollment>
  <condition>Low Back Pain</condition>
  <condition>Pain Measurement</condition>
  <condition>Chronic Pain</condition>
  <condition>Analgesia, Epidural</condition>
  <condition>Clinic, Pain</condition>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Fluoroscopically guided lumbar medial branch nerve radiofrequency denervation.</intervention_name>
    <description>While in prone position, lumbar facet joints are identified by fluoroscopy. 18 gauge needles are then advanced aiming to the medial branch of lumbar facet joints. Correct positioning is confirmed by anteroposterior and lateral fluoroscopy. Then, the needles are attached to the radiofrequency device. Correct positioning of the needles is confirmed also by sensitive stimulation (paresthesia evocation) with the following settings: 50 Hz (hertz), 1ms, 0,6V (volts). In order to avoid motor lesion, it is confirmed that no motor response is produced with 2Hz, 2ms (millisecond) and twice the voltage that produced sensitive response. After correct positioning and repositioning the needles if needed, conventional radiofrequency ablation of medial branch nerves is performed using the following settings: 90 seconds, 80º Celsius degrees.&#xD;
The selection of target facet joints is made based on clinical findings. Some patients receive bilateral while other unilateral facet joint denervation.</description>
  </intervention>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Fluoroscopically guided lumbar facet joint injection.</intervention_name>
    <description>With the patient in prone position and guided by fluoroscopy, lumbar facet joints are identified. The 22 french needles are then advanced aiming to the lumbar facet joints. Correct positioning is confirmed with anteroposterior and lateral fluoroscopy. A mixture of 3 ml of ropivacaine 0,2% + 1 ml (40 mg) of triamcinolone (trigon depot) is prepared. 1 ml of the mixture is injected in each lumbar facet joint through the needles. Four facet joints are selected for therapy. Some patients receive bilateral and other unilateral but contiguous facet joint infiltration. The selection of target facet joints is made based on clinical and radiological findings.</description>
  </intervention>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Fluoroscopically guided lumbar epidural corticosteroid injection.</intervention_name>
    <description>With the patient in prone position and guided by fluoroscopy, an epidural needle attached to a syringe filled with saline serum is advanced through the interlaminar approach using a loss of resistance technique for the identification of the lumbar epidural space. When loss of resistance is encountered, 1 ml of iodinated contrast is injected. After fluoroscopical confirmation of epidural spilling, a mixture of 4 ml of ropivacaine 0,1%, 2 ml (12 mg) of betamethasone and 2 ml of saline serum is injected in the epidural space. The lumbar level to which it infiltrates depends on each patient.</description>
  </intervention>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Fluoroscopically guided caudal epidural corticosteroid injection.</intervention_name>
    <description>With the patient in prone position and guided by fluoroscopy, an epidural needle attached to a syringe filled with saline serum is advanced through the sacral hiatus using a loss of resistance technique for the identification of the epidural space. When loss of resistance is encountered, 2 ml of iodinated contrast is injected. After fluoroscopical confirmation of epidural spilling, a mixture of 7 ml of ropivacaine 0,2%, 2 ml (12 mg) of betamethasone and 7 ml of saline serum is injected in the epidural space.</description>
  </intervention>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Fluoroscopically guided pulsed radiofrequency of the lumbar dorsal root ganglion.</intervention_name>
    <description>With the patient in prone position and guided by fluoroscopy, a 18 gauge needle is advanced aiming to the intervertebral foramen. Patient is cautioned about the paresthesia which will be felt. A lateral view was taken occasionally to confirm position. 0.5 ml of iodinated contrast is injected to confirm the position of the needle. Then 1 ml of the combination of 12mg of betamethasone and 1ml of ropivacaine 0.2% is injected over the affected root. Then, the needle is attached to the radiofrequency device. Correct positioning of the needles is confirmed also by sensitive stimulation (paresthesia evocation) with the following settings: 50 Hz, 1ms, 0,6V. In order to avoid motor lesion, it is confirmed that no motor response is produced with 2Hz, 2ms and twice the voltage that produced sensitive response. After correct positioning is confirmed, pulsed radiofrequency ablation of lumbar dorsal root ganglion is performed using the following settings: 4 minutes, 42ºC (degrees Celsius).</description>
  </intervention>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Fluoroscopically guided transforaminal epidural corticosteroid injection or lumbar selective root block.</intervention_name>
    <description>With the patient in prone position and guided by fluoroscopy, a 22 french needle is then advanced aiming to the intervertebral foramen. Patient is cautioned about the paresthesia which will be felt along the course of the lumbar root when the needle touches the nerve. A lateral view was taken occasionally to confirm position. 0.5 ml of iodinated contrast is injected to confirm the position of the needle. Then 1 ml of the combination of 12mg of betamethasone and 1ml of ropivacaine 0.2% is injected over the affected root.</description>
  </intervention>
  <eligibility>
    <study_pop>
      <textblock>
        Study population consist of adult outpatients with chronic low back pain in the Chronic&#xD;
        Pain Unit of our University Hospital.&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Non-Probability Sample</sampling_method>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Patients older than 18 years old with chronic lumbar pain to whom one of the following&#xD;
             interventional pain management techniques has been indicated:&#xD;
&#xD;
          -  Radiofrequency lumbar facet joint injection&#xD;
&#xD;
          -  Radiofrequency lumbar facet joint denervation&#xD;
&#xD;
          -  Lumbar epidural corticosteroid injection&#xD;
&#xD;
          -  Caudal epidural corticosteroid injection&#xD;
&#xD;
          -  Pulsed radiofrequency of the lumbar dorsal root ganglion&#xD;
&#xD;
          -  Dorsal root ganglion injection&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Patients that have not undergone the interventional pain management technique. The&#xD;
             interventional pain management technique is considered not performed if it is not done&#xD;
             after a twelve month period after recruitment.&#xD;
&#xD;
          -  Patients who are not willing to participate.&#xD;
&#xD;
          -  Patients of whom it is impossible to obtain data of response.&#xD;
&#xD;
          -  Patients who undergo low back surgery while they are in the study.&#xD;
&#xD;
          -  Patients who suffer from an intercurrent disease that may interfere with the&#xD;
             evaluation of chronic lumbar pain.&#xD;
&#xD;
          -  Patients who suffer from myofascial pain syndromes.&#xD;
&#xD;
          -  Patients who undergo pulsed radiofrequency denervation for the treatment of sacroiliac&#xD;
             joint syndrome.&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
  </eligibility>
  <overall_official>
    <last_name>Santiago Garcia-Hernandez</last_name>
    <role>Principal Investigator</role>
    <affiliation>Hospital General Universitario Gregorio Maranon</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Ana Esther Lopez Perez</last_name>
    <role>Study Chair</role>
    <affiliation>Hospital General Universitario Gregorio Maranon</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Fernando Higuero-Cantonero</last_name>
    <role>Principal Investigator</role>
    <affiliation>Hospital General Universitario Gregorio Maranon</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Hospital General Universitario Gregorio Maranon</name>
      <address>
        <city>Madrid</city>
        <zip>28007</zip>
        <country>Spain</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Spain</country>
  </location_countries>
  <reference>
    <citation>Sivaganesan A, Chotai S, Parker SL, Asher AL, McGirt MJ, Devin CJ. Predictors of the efficacy of epidural steroid injections for structural lumbar degenerative pathology. Spine J. 2016 Aug;16(8):928-34. doi: 10.1016/j.spinee.2015.11.058. Epub 2015 Dec 9.</citation>
    <PMID>26689476</PMID>
  </reference>
  <reference>
    <citation>Manchikanti L, Buenaventura RM, Manchikanti KN, Ruan X, Gupta S, Smith HS, Christo PJ, Ward SP. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician. 2012 May-Jun;15(3):E199-245.</citation>
    <PMID>22622912</PMID>
  </reference>
  <reference>
    <citation>Cyteval C, Fescquet N, Thomas E, Decoux E, Blotman F, Taourel P. Predictive factors of efficacy of periradicular corticosteroid injections for lumbar radiculopathy. AJNR Am J Neuroradiol. 2006 May;27(5):978-82.</citation>
    <PMID>16687527</PMID>
  </reference>
  <reference>
    <citation>Park DY, Kang S, Park JH. Factors Predicting Favorable Short-Term Response to Transforaminal Epidural Steroid Injections for Lumbosacral Radiculopathy. Medicina (Kaunas). 2019 May 18;55(5):162. doi: 10.3390/medicina55050162.</citation>
    <PMID>31109045</PMID>
  </reference>
  <verification_date>August 2021</verification_date>
  <study_first_submitted>June 15, 2020</study_first_submitted>
  <study_first_submitted_qc>June 25, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">June 30, 2020</study_first_posted>
  <last_update_submitted>August 23, 2021</last_update_submitted>
  <last_update_submitted_qc>August 23, 2021</last_update_submitted_qc>
  <last_update_posted type="Actual">August 24, 2021</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor-Investigator</responsible_party_type>
    <investigator_affiliation>Hospital General Universitario Gregorio Marañon</investigator_affiliation>
    <investigator_full_name>Santiago Garcia-Hernandez</investigator_full_name>
    <investigator_title>Aneaesthesiology, Critical Care and Pain Medicine Resident Trainee. Hospital General Universitario Gregorio Marañon.</investigator_title>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Back Pain</mesh_term>
    <mesh_term>Low Back Pain</mesh_term>
    <mesh_term>Chronic Pain</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04451252
org study id: PRETI-DOL-V1
nct id: NCT04451252
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
The main aim of this study is to identify factors that may be associated with a better or
      worse response to interventional pain management therapies for the treatment of chronic
      lumbar pain in adult patients. If several predictive factors are to be identified, a
      predictive model will be developed.
Chronic lumbar pain is a common affection in the adult population, and an important source of
      chronic incapacity and impaired quality of life. There is a wide range of therapeutic options
      for the treatment of chronic lumbar pain. This study will analyze the response to several
      interventional pain management techniques and will search for factors that may be associated
      to a better or worse response to the techniques.
observational model: Other
time perspective: Prospective
measure: Clinical response to IPMT after 4 weeks follow-up after the IPMT is performed (composite outcome)
time frame: Baseline (prior to the Interventional Pain Management Therapy); Week 4 after IPMT
description: Clinical response after 4 week follow-up is going to be defined as composite outcomes:
Positive strong response (PSR-4W): a positive strong response to the interventional pain management therapy after 4 weeks follow-up is defined as a composite outcome. Patients must meet both the following criteria:
A decrease in Numeric Rating Scale of at least 3 points.
A decrease in the Oswestry Disability Index of al least 40%.
Positive moderate response (PMR-4W): a positive moderate response to the interventional pain management therapy after 4 weeks follow-up is defined as a composite outcome. Patients must meet both the following criteria:
A decrease in Numeric Rating Scale of at least 2 points.
A decrease in the Oswestry Disability Index of al least 20%.
No response (NR-4W): no response to IPMT after 4 weeks follow-up is defined as those patients not included in either of the previous categories.
measure: Factors that may be associated with no response to the IPMT at 4 weeks follow-up.
time frame: Response will be measured after 4 weeks follow-up after the IPMT.
description: 14 candidate variables will be analyzed for association to no response to the IPMT at 4 weeks (NR-4W). All the variables are qualitative, dichotomic, yes/no:
Work sick leave.
Depression/Anxiety.
Obesity.
Existence of another chronic pain.
Failed back surgery syndrome.
Radicular compression in imaging.
Herniated disc in imaging.
Radiate pain.
Age: older than 65 years old (>65 years old).
Chronic therapy with opioid medication.
Chronic therapy with gabapentionids.
Chronic therapy with opioid medication AND gabapentinoids.
Clinical Frailty Scale >3 (≥4).
Initial Oswestry Disability Index ≥40.
measure: Factors that may be associated with a positive response to the IPMT (PSR-4W or PMR-4W).
time frame: Response will be measured after 4 weeks follow-up.
description: 14 candidate variables will be analyzed for association to PSR-4W or PMR-4W to the IPMT at 4 weeks. All the variables are qualitative, dichotomic, yes/no:
Working.
Depression/Anxiety.
Obesity.
Failed back surgery syndrome.
Radicular compression in imaging.
Herniated disc in imaging.
Radiate pain.
Age: younger than 45 years old (<45 years old).
Chronic therapy with opioid medication.
Chronic therapy with gabapentinoids medication.
Chronic therapy with opioid medication AND gabapentinoids.
Clinical Frailty Scale <3.
Initial Oswestry Disability Index ≥40.
Subjective good subjective result in previous performed interventional pain management therapies.
measure: Clinical response to IPMT after 24 weeks follow-up after the IPMT is performed (composite outcome).
time frame: Response will be measured after 24 weeks follow-up after the IPMT.
description: Clinical response after 24 week follow-up is going to be defined as composite outcomes:
Positive strong response (PSR-24W): a positive strong response to the interventional pain management therapy after 24 weeks follow-up is defined as a composite outcome. Patients must meet both the following criteria:
A decrease in Numeric Rating Scale of at least 3 points.
A decrease in the Oswestry Disability Index of al least 40%.
Positive moderate response (PMR-24W): a positive moderate response to the interventional pain management therapy after 24 weeks follow-up is defined as a composite outcome. Patients must meet both the following criteria:
A decrease in Numeric Rating Scale of at least 2 points.
A decrease in the Oswestry Disability Index of al least 20%.
No response (NR-24W): no response to IPMT after 24 weeks follow-up is defined as those patients not included in either of the previous categories.
measure: Factors that may be associated with no response to the IPMT at 24 weeks follow-up.
time frame: The factors will be recorded at baseline; the response will be measured at after 24 weeks follow-up.
description: 14 candidate variables will be analyzed for association to no response to the IPMT at 24 weeks (NR-24W). All the variables are qualitative, dichotomic, yes/no:
Work sick leave.
Depression/Anxiety.
Obesity.
Existence of another chronic pain.
Failed back surgery syndrome.
Radicular compression in imaging.
Herniated disc in imaging.
Radiate pain.
Age: older than 65 years old (>65 years old).
Chronic therapy with opioid medication.
Chronic therapy with gabapentinoids medication.
Chronic therapy with opioid medication AND gabapentinoids.
Clinical Frailty Scale >3 (≥4).
Initial Oswestry Disability Index ≥40.
measure: Factors that may be associated with a positive response to the IPMT after a 24 weeks follow-up (PSR-24W or PMR-24W).
time frame: Response will be measured after 24 weeks follow-up after the IPMT.
description: 14 candidate variables will be analyzed for association to PSR-4W or PMR-4W to the IPMT at 24 weeks. All the variables are qualitative, dichotomic, yes/no:
Working.
Depression/Anxiety.
Obesity.
Failed back surgery syndrome.
Radicular compression in imaging.
Herniated disc in imaging.
Radiate pain.
Age: younger than 45 years old (<45 years old).
Chronic therapy with opioid medication.
Chronic therapy with gabapentinoids medication.
Chronic therapy with opioid medication AND gabapentinoids.
Clinical Frailty Scale <3.
Initial Oswestry Disability Index ≥40.
Good subjective result in previous performed interventional pain management therapies.
measure: Validation a predictive model for positive response to the IPMT after 4 weeks
time frame: Response will be measured after 4 weeks follow-up after the IPMT.
description: In case that several predictive variables are identified, a predictive model will be developed, either for predicting good and/or bad response.
measure: Validation a predictive model for positive response to the IPMT after 24 weeks
time frame: Response will be measured after 24 weeks follow-up after the IPMT.
description: In case that several predictive variables are identified, a predictive model will be developed, either for predicting good and/or bad response.
measure: Identifying other variables that may be associated with a good or bad response to an interventional pain management therapy (IPMT) at 4 weeks
time frame: Response will be measured after 4 weeks follow-up after the IPMT
description: Other variables recorded in the Data Collection Logbook of our study will be analyzed looking for other associations:
Fibromyalgia.
Depression, anxiety and/or mixed axiety-depressive disorder.
Obesity.
Other chronic pain.
Failed back surgery syndrome.
Osteoporotic fracture.
Lumbar canal stenosis syndrome.
Irradiated pain to leg.
Diabetes Mellitus.
Arthrosis.
Inflammatory arthritis.
Oncologic condition.
Osteoporosis.
Substance abuse disorder.
measure: Identifying other variables that may be associated with a good or bad response to an interventional pain management therapy (IPMT) at 24 weeks
time frame: Response will be measured after 24 weeks follow-up after the IPMT
description: Other variables recorded in the Data Collection Logbook of our study will be analyzed looking for other associations:
Fibromyalgia.
Depression, anxiety and/or mixed axiety-depressive disorder.
Obesity.
Other chronic pain.
Failed back surgery syndrome.
Osteoporotic fracture.
Lumbar canal stenosis syndrome.
Irradiated pain to leg.
Diabetes Mellitus.
Arthrosis.
Inflammatory arthritis.
Oncologic condition.
Osteoporosis.
Substance abuse disorder.
measure: Analyzing the response after 4 weeks to therapy of each interventional pain management therapy alone, and which variables may be associated with a better response to therapy.
time frame: Response will be measured after 4 weeks follow-up after the IPMT
description: The therapies that will be analyzed are:
Fluoroscopically guided lumbar medial branch nerve radiofrequency denervation.
Fluoroscopically guided lumbar facet joint injection.
Fluoroscopically guided lumbar epidural corticosteroid injection.
Fluoroscopically guided caudal epidural corticosteroid injection.
Fluoroscopically guided pulsed radiofrequency of the lumbar dorsal root ganglion.
Fluoroscopically guided transforaminal epidural corticosteroid injection or lumbar selective root block.
measure: Analyzing the response after 24 weeks to therapy of each interventional pain management therapy alone, and which variables may be associated with a better response to therapy.
time frame: Response will be measured after 24 weeks follow-up after the IPMT
description: The therapies that will be analyzed are:
Fluoroscopically guided lumbar medial branch nerve radiofrequency denervation.
Fluoroscopically guided lumbar facet joint injection.
Fluoroscopically guided lumbar epidural corticosteroid injection.
Fluoroscopically guided caudal epidural corticosteroid injection.
Fluoroscopically guided pulsed radiofrequency of the lumbar dorsal root ganglion.
Fluoroscopically guided transforaminal epidural corticosteroid injection or lumbar selective root block.
measure: Studying the association between main clinical diagnosis and the response to therapy, globally and stratified by single IPMT, after 4 weeks of the IPMT
time frame: Response will be measured after 4 weeks follow-up after the IPMT
description: Main clinical diagnosis, response to therapy and IPMT performed are described separately as outcomes.
measure: Studying the association between main clinical diagnosis and the response to therapy, globally and stratified by single IPMT, after 24 weeks of the IPMT
time frame: Response will be measured after 24 weeks follow-up after the IPMT
description: Main clinical diagnosis, response to therapy and IPMT performed are described separately as outcomes.
measure: Studying the satisfaction of the patients to the IPMT performed, after 24 weeks of IPMT
time frame: Satisfaction will be measured after 24 weeks follow-up after the IPMT
description: Patient satisfaction will be assessed as two separate YES/NO questions:
Are you satisfied with the pain-relief obtained after you underwent the Interventional Pain Management Technique? (YES/NO answer).
Based on your experience, would you undergo the same treatment again? (YES/NO answer).
measure: Studying the satisfaction of the patients to the IPMT performed, after 4 weeks of IPMT
time frame: Satisfaction will be measured after 4 weeks follow-up after the IPMT
description: Patient satisfaction will be assessed as two separate YES/NO questions:
- Are you satisfied with the pain-relief obtained after you underwent the Interventional Pain Management Technique? (YES/NO answer).
Patient satisfaction will be assessed as two separate YES/NO questions:
Are you satisfied with the pain-relief obtained after you underwent the Interventional Pain Management Technique? (YES/NO answer).
Based on your experience, would you undergo the same treatment again? (YES/NO answer).
measure: Studying the correlation of both scales (Numeric Rating Scale and Oswestry Disability Index) and patient satisfaction after 4 weeks of the IPMT
time frame: Response and satisfaction will be measured after 4 weeks follow-up after the IPMT
description: Patient satisfaction will be assessed as two separate YES/NO questions:
Are you satisfied with the pain-relief obtained after you underwent the Interventional Pain Management Technique? (YES/NO answer).
Based on your experience, would you undergo the same treatment again? (YES/NO answer).
measure: Studying the correlation of both scales (Numeric Rating Scale and Oswestry Disability Index) and patient satisfaction after 24 weeks of the IPMT
time frame: Response and satisfaction will be measured after 24 weeks follow-up after the IPMT
description: Patient satisfaction will be assessed as two separate YES/NO questions:
Are you satisfied with the pain-relief obtained after you underwent the Interventional Pain Management Technique? (YES/NO answer).
Based on your experience, would you undergo the same treatment again? (YES/NO answer).
measure: Studying the epidemiology and evolution of the pharmacological therapy of our population (Part I)
time frame: Drug therapy will be recorded at baseline
description: Variable #1. Qualitative; is the patient taking any of the following medications (YES/NO for each treatment) at visit 0?:
Acetanomiphen.
Metamizole.
NSAID #1 (specify which).
NSAID #1 (specify which).
Gabapentine.
Pregabaline.
Tramadol.
Tapentadol.
Oxicodone.
Metadone.
Transdermic Fentanyl.
Transdermic Buprenorphine.
Amitriptiline.
Desipramine.
Nortriptiline.
Duloxetine.
Desvenlafaxine.
Paroxetine.
Citalopram.
Transdermic lidocaine.
Transdermic capsaicine.
Benzodiacepine (specify which).
Dexametasone.
Prednisone.
Hidrocodone.
Hidromorphone.
Oximorphine.
Minalcipram.
Bupropion.
Valproate.
Carbamazepine.
Lamotrigine.
Other (1) (specify which).
Other (2) (specify which).
Other (3) (specify which).
Variable #2. Quantitative. 24 hour dose of each pharmacologic treatment the patient is taking at visit 0.
measure: Studying the epidemiology and evolution of the pharmacological therapy of our population (Part II)
time frame: Drug therapy will be recorded at baseline; change in therapy will be recorded vs 4 weeks and vs 24 weeks.
description: Variable #3. Qualitative. Is the patient taking any pharmacological treatment belonging to any of the following cathegories?:
NSAIDs, acetanomiphen, metamizole.
Opioids.
Oral opioids.
Minor opioids (tramadol, tapendatol, codeine)
Strong opioids.
Transdermic opioids.
Gabapentinoids.
Antidepressants.
Benzodiazepines.
Anticonvulsivants.
Variable #4. Qualitative. Has it been any change in pharmacological treatment in the follow-up (baseline vs 4 weeks and vs 24 weeks) ; related to each pharmacological treatment)?:
Unchanged.
Higher dose.
Lower dose.
Treatment stopped.
Variable #5. Qualitative. Why was the pharmacological treatment changed (baseline vs 4 weeks and vs 24 weeks) ?:
Clinical improvement.
Secondary effects.
Change for another pharmacological treatment.
measure: Studying the safety and potential adverse reactions to IPMT.
time frame: Potential adverse reactions will be measured at the end of follow-up (after 24 weeks of the IPMT)
description: Several cathegories:
Postdural puncture headache.
Infectious complication.
Epidural hematoma.
Neurologic damage.
Other (specify).
measure: Studying the epidemiology of radiological findings in our population, and its association with the IPMT performed and the response to therapy after 4 weeks.
time frame: Response will be measured after 4 weeks follow-up after the IPMT
description: Several cathegories or radiological findings:
Discopathy.
Herniated disk.
Central stenosis.
Lateral stenosis.
Radicular compression.
Spondyloarthrosis.
Spondylolisthesis.
Epidural fibrosis.
Reumatic inflammatory disease.
Vertebral compression fracture.
Scoliosis.
Other (specify).
measure: Studying the epidemiology of radiological findings in our population, and its association with the IPMT performed and the response to therapy after 24 weeks.
time frame: Response will be measured after 24 weeks follow-up after the IPMT
description: Several cathegories or radiological findings:
Discopathy.
Herniated disk.
Central stenosis.
Lateral stenosis.
Radicular compression.
Spondyloarthrosis.
Spondylolisthesis.
Epidural fibrosis.
Reumatic inflammatory disease.
Vertebral compression fracture.
Scoliosis.
Other (specify).
measure: Studying the epidemiology of radiological findings in our population, and its association with clinical findings and clinical diagnosis.
time frame: Response will be measured after 24 weeks follow-up after the IPMT
description: Several cathegories:
Discopathy.
Herniated disk.
Central stenosis.
Lateral stenosis.
Radicular compression.
Spondyloarthrosis.
Spondylolisthesis.
Epidural fibrosis.
Reumatic inflammatory disease.
Vertebral compression fracture.
Scoliosis.
Other (specify).
Clinical findings are:
Fibromyalgia.
Failed back surgery syndrome.
Osteoporotic fracture.
Lumbar canal stenosis syndrome.
Irradiated pain to leg.
Arthrosis.
Inflammatory arthritis.
Oncologic condition.
Osteoporosis.
Clinical diagnosis are defined as another outcome measure.
measure: Analyzing the epidemiology of comorbidities (pain and not pain related) in our population:
time frame: Comorbidites will be recorded at baseline
description: Comorbities that will be analyzed are:
Fibromyalgia.
Depression, anxiety and/or mixed axiety-depressive disorder.
Obesity.
Other chronic pain.
Failed back surgery syndrome.
Osteoporotic fracture.
Lumbar canal stenosis syndrome.
Irradiated pain to leg.
Diabetes Mellitus.
Arthrosis.
Inflammatory arthritis.
Oncologic condition.
Osteoporosis.
Substance abuse disorder.
measure: Analyzing the demographical data of the study population.
time frame: Demographical data will be obtained at baseline
description: Age, sex, marital status, working status at ethnic group and Medical Specialty that derivated the patient to our unit will be recorded at base line.
Working status: It will classified as: "active worker", "work sick leave", "studying", "retired person", "incapacitated to work" and "convict"
Marital status: It will classified as: "single", "unmarried partner", "married", "divorced" and "widowed".
Ethnic group: It will be classified as: "caucasic", "african"; "latin", "asiatic", "romany" and "other".
measure: Studying the evolution in time of the response to the IPMT.
time frame: the response will be measured at +4weeks, +8weeks and +24 weeks
description: Positive strong response, both strong (PSR) and moderate (PMR), as defined in "Primary outcomes" will be measured both at baseline vs 4 weeks follow-up, baseline vs 24 weeks follow-up and baseline vs 8 weeks follow-up.
The evolution of the pain response will be studied; response and satisfaction will be measured at 4 different moments:
Baseline (prior to the performance of the IPMT).
4 weeks after the IPMT is performed.
8 weeks after the IPMT is performed.
24 weeks after the IPMT is performed.
measure: Charlson comorbidity index
time frame: Calculated at baseline
description: Charlson comorbidity index will be calculated at baseline.
measure: Pain syndrome
time frame: Pain syndrome is diagnosed at baseline
description: Variable 1: presence of any of the following diagnosis:
Facet joint syndrome.
Vertebral crush fracture.
Discogenic pain.
Lateral lumbar canal stenosis.
Sacroiliac pain syndrome.
Central lumbar canal stenosis.
Failed back surgery syndrome.
None of the previous diagnosis. Variable n 2. Main pain syndrome, which is the one that motivates the IPMT.
Facet joint syndrome.
Vertebral crush fracture.
Discogenic pain.
Lateral lumbar canal stenosis.
Sacroiliac pain syndrome.
Central lumbar canal stenosis.
Failed back surgery syndrome.
None of the previous diagnosis.
There is no main pain syndrome: the patient has multiple pain diagnosis, and no single one prevails among the others. The IPMT is under a mixed therapeutic and diagnostic approach.
Variable n3: number of pain syndromes present in the patient, of all the above.
measure: Main operator of the IPMT
time frame: Measured 4 weeks after IPMT is performed
description: Two cathegories:
Attending Pain Physician.
Anestesiology Resident.
measure: Previous treatments, and success
time frame: Measured at baseline
description: Variables n1 and n 2 are qualitative. Measured at visit 0.
Variable n 1: the patient has undergone any of these treatments:
Back surgery.
Previous IPMT.
No IPMT.
Variable n 2: subjective satisfaction of the patient:
Satisfied.
Not satisfied.
measure: Numeric Rating Scale of pain at baseline
time frame: baseline
description: The 11-point numerical pain rating scale (NRS) is a measure of pain in which patients rate their pain ranging from 0 (no pain) to 10 (worst imaginable pain). Validated in Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30:1331-4.
measure: Numeric Rating Scale of pain at 4 weeks after the IPMT is performed
time frame: 4 weeks after the IPMT is performed
description: The 11-point numerical pain rating scale (NRS) is a measure of pain in which patients rate their pain ranging from 0 (no pain) to 10 (worst imaginable pain). Validated in Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30:1331-4.
measure: Numeric Rating Scale of pain at 8 weeks after the IPMT is performed
time frame: 8 weeks after the IPMT is performed
description: The 11-point numerical pain rating scale (NRS) is a measure of pain in which patients rate their pain ranging from 0 (no pain) to 10 (worst imaginable pain). Validated in Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30:1331-4.
measure: Numeric Rating Scale of pain at 24 weeks after the IPMT is performed
time frame: 24 weeks after the IPMT is performed
description: The 11-point numerical pain rating scale (NRS) is a measure of pain in which patients rate their pain ranging from 0 (no pain) to 10 (worst imaginable pain). Validated in Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30:1331-4.
measure: Oswestry Disability Index at baseline
time frame: baseline
description: Original version 1 (1980), translated and adapted to Spanish (1995), validated.
measure: Oswestry Disability Index at 4 weeks after the IPMT is performed
time frame: 4 weeks after the IPMT is performed
description: Original version 1 (1980), translated and adapted to Spanish (1995), validated.
measure: Oswestry Disability Index at 8 weeks after the IPMT is performed
time frame: 8 weeks after the IPMT is performed
description: Original version 1 (1980), translated and adapted to Spanish (1995), validated.
measure: Oswestry Disability Index at 24 weeks after the IPMT is performed
time frame: 24 weeks after the IPMT is performed
description: Original version 1 (1980), translated and adapted to Spanish (1995), validated.
measure: Clinical Frailty Scale at baseline
time frame: Obtained at baseline
description: As described by Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173:489-95.
measure: Previous treatments, and success
time frame: Mesured at baseline
description: Variables n1 and n 2 are qualitative. Measured at visit 0.
Variable n 1: the patient has undergone any of these treatments:
Back surgery.
Previous IPMT.
No IPMT.
Variable n 2: subjective satisfaction of the patient:
Satisfied.
Not satisfied.
measure: Interventional Pain Management Technique indicated at visit 0.
time frame: Baseline
description: Several cathegories:
Fluoroscopically guided lumbar medial branch nerve radiofrequency denervation.
Fluoroscopically guided lumbar facet joint injection.
Fluoroscopically guided lumbar epidural corticosteroid injection.
Fluoroscopically guided caudal epidural corticosteroid injection.
Fluoroscopically guided pulsed radiofrequency of the lumbar dorsal root ganglion.
Fluoroscopically guided transforaminal epidural corticosteroid injection or lumbar selective root block.
measure: Interventional Pain Management Technique performed.
time frame: Measured 4 weeks after the IPMT
description: Several cathegories:
Fluoroscopically guided lumbar medial branch nerve radiofrequency denervation.
Fluoroscopically guided lumbar facet joint injection.
Fluoroscopically guided lumbar epidural corticosteroid injection.
Fluoroscopically guided caudal epidural corticosteroid injection.
Fluoroscopically guided pulsed radiofrequency of the lumbar dorsal root ganglion.
Fluoroscopically guided transforaminal epidural corticosteroid injection or lumbar selective root block.
measure: Imaging modality
time frame: Baseline
description: Qualitative:
MRI.
ST scan.
Lumbar x-ray.
intervention type: Procedure
intervention name: Fluoroscopically guided lumbar medial branch nerve radiofrequency denervation.
description: While in prone position, lumbar facet joints are identified by fluoroscopy. 18 gauge needles are then advanced aiming to the medial branch of lumbar facet joints. Correct positioning is confirmed by anteroposterior and lateral fluoroscopy. Then, the needles are attached to the radiofrequency device. Correct positioning of the needles is confirmed also by sensitive stimulation (paresthesia evocation) with the following settings: 50 Hz (hertz), 1ms, 0,6V (volts). In order to avoid motor lesion, it is confirmed that no motor response is produced with 2Hz, 2ms (millisecond) and twice the voltage that produced sensitive response. After correct positioning and repositioning the needles if needed, conventional radiofrequency ablation of medial branch nerves is performed using the following settings: 90 seconds, 80º Celsius degrees.
The selection of target facet joints is made based on clinical findings. Some patients receive bilateral while other unilateral facet joint denervation.
intervention type: Procedure
intervention name: Fluoroscopically guided lumbar facet joint injection.
description: With the patient in prone position and guided by fluoroscopy, lumbar facet joints are identified. The 22 french needles are then advanced aiming to the lumbar facet joints. Correct positioning is confirmed with anteroposterior and lateral fluoroscopy. A mixture of 3 ml of ropivacaine 0,2% + 1 ml (40 mg) of triamcinolone (trigon depot) is prepared. 1 ml of the mixture is injected in each lumbar facet joint through the needles. Four facet joints are selected for therapy. Some patients receive bilateral and other unilateral but contiguous facet joint infiltration. The selection of target facet joints is made based on clinical and radiological findings.
intervention type: Procedure
intervention name: Fluoroscopically guided lumbar epidural corticosteroid injection.
description: With the patient in prone position and guided by fluoroscopy, an epidural needle attached to a syringe filled with saline serum is advanced through the interlaminar approach using a loss of resistance technique for the identification of the lumbar epidural space. When loss of resistance is encountered, 1 ml of iodinated contrast is injected. After fluoroscopical confirmation of epidural spilling, a mixture of 4 ml of ropivacaine 0,1%, 2 ml (12 mg) of betamethasone and 2 ml of saline serum is injected in the epidural space. The lumbar level to which it infiltrates depends on each patient.
intervention type: Procedure
intervention name: Fluoroscopically guided caudal epidural corticosteroid injection.
description: With the patient in prone position and guided by fluoroscopy, an epidural needle attached to a syringe filled with saline serum is advanced through the sacral hiatus using a loss of resistance technique for the identification of the epidural space. When loss of resistance is encountered, 2 ml of iodinated contrast is injected. After fluoroscopical confirmation of epidural spilling, a mixture of 7 ml of ropivacaine 0,2%, 2 ml (12 mg) of betamethasone and 7 ml of saline serum is injected in the epidural space.
intervention type: Procedure
intervention name: Fluoroscopically guided pulsed radiofrequency of the lumbar dorsal root ganglion.
description: With the patient in prone position and guided by fluoroscopy, a 18 gauge needle is advanced aiming to the intervertebral foramen. Patient is cautioned about the paresthesia which will be felt. A lateral view was taken occasionally to confirm position. 0.5 ml of iodinated contrast is injected to confirm the position of the needle. Then 1 ml of the combination of 12mg of betamethasone and 1ml of ropivacaine 0.2% is injected over the affected root. Then, the needle is attached to the radiofrequency device. Correct positioning of the needles is confirmed also by sensitive stimulation (paresthesia evocation) with the following settings: 50 Hz, 1ms, 0,6V. In order to avoid motor lesion, it is confirmed that no motor response is produced with 2Hz, 2ms and twice the voltage that produced sensitive response. After correct positioning is confirmed, pulsed radiofrequency ablation of lumbar dorsal root ganglion is performed using the following settings: 4 minutes, 42ºC (degrees Celsius).
intervention type: Procedure
intervention name: Fluoroscopically guided transforaminal epidural corticosteroid injection or lumbar selective root block.
description: With the patient in prone position and guided by fluoroscopy, a 22 french needle is then advanced aiming to the intervertebral foramen. Patient is cautioned about the paresthesia which will be felt along the course of the lumbar root when the needle touches the nerve. A lateral view was taken occasionally to confirm position. 0.5 ml of iodinated contrast is injected to confirm the position of the needle. Then 1 ml of the combination of 12mg of betamethasone and 1ml of ropivacaine 0.2% is injected over the affected root.
study pop: 
sampling method: Non-Probability Sample
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
last name: Santiago Garcia-Hernandez
role: Principal Investigator
affiliation: Hospital General Universitario Gregorio Maranon
last name: Ana Esther Lopez Perez
role: Study Chair
affiliation: Hospital General Universitario Gregorio Maranon
last name: Fernando Higuero-Cantonero
role: Principal Investigator
affiliation: Hospital General Universitario Gregorio Maranon
facility: 
country: Spain
citation: Sivaganesan A, Chotai S, Parker SL, Asher AL, McGirt MJ, Devin CJ. Predictors of the efficacy of epidural steroid injections for structural lumbar degenerative pathology. Spine J. 2016 Aug;16(8):928-34. doi: 10.1016/j.spinee.2015.11.058. Epub 2015 Dec 9.
PMID: 26689476
citation: Manchikanti L, Buenaventura RM, Manchikanti KN, Ruan X, Gupta S, Smith HS, Christo PJ, Ward SP. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician. 2012 May-Jun;15(3):E199-245.
PMID: 22622912
citation: Cyteval C, Fescquet N, Thomas E, Decoux E, Blotman F, Taourel P. Predictive factors of efficacy of periradicular corticosteroid injections for lumbar radiculopathy. AJNR Am J Neuroradiol. 2006 May;27(5):978-82.
PMID: 16687527
citation: Park DY, Kang S, Park JH. Factors Predicting Favorable Short-Term Response to Transforaminal Epidural Steroid Injections for Lumbosacral Radiculopathy. Medicina (Kaunas). 2019 May 18;55(5):162. doi: 10.3390/medicina55050162.
PMID: 31109045
responsible party type: Sponsor-Investigator
investigator affiliation: Hospital General Universitario Gregorio Marañon
investigator full name: Santiago Garcia-Hernandez
investigator title: Aneaesthesiology, Critical Care and Pain Medicine Resident Trainee. Hospital General Universitario Gregorio Marañon.
mesh term: Back Pain
mesh term: Low Back Pain
mesh term: Chronic Pain
sharing ipd: No