Use of Lower Back Pain Interventions in the Back pain Outcomes using Longitudinal Data (BOLD) Cohort ASNR Annual Meeting May 2016 Presentation eP Falgun H. Chokshi, MD, MS 1 2.Sean Rundell, PhD 2 3.Janna L. Friedly, MD 2 4.Zoya A. Bauer, PhD 3 5.Pradeep Suri, MD, MS 4 6.Laurie Gold, PhD 3 7.Bryan Comstack, PhD 5 1 Emory University School of Medicine-Department of Radiology & Imaging Sciences, Atlanta, GA, 2 University of Washington-Department of Rehabilitation Medicine, Seattle, WA, 3 University of Washington-Department of Radiology, Seattle, WA, 4 VA Puget Sound Health Care System, Seattle, WA, 5 University of Washington-Department of Biostatistics, Seattle, WA, 6 Weill Cornell Medicine- Department of Rehabilitation Medicine, New York, NY, 7 Brigham and Women's Hospital- Department of Anesthesiology, Perioperative and Pain Medicine, Boston, MA, 8 Kaiser Permanente, Northern California - Division of Research, Oakland, CA, 9 Henry Ford Health System-Neuroscience Institute, Detroit, MI, 10 Henry Ford Health System-Orthopedic Surgery, Detroit, MI 8.Alfred C. Gellhorn, MD 6 9.Srdjan Nedeljkovic, MD 7 10.Andrew L. Avins, MD, MPH 8 11.David R. Nerenz, PhD 9 12.Shlomo S. Mandel, MD Jeffrey G. Jarvik, MD, MPH 3

Disclosures Jeffrey G. Jarvik, MD, MPH: Physiosonix (ultrasound company): Founder/stockholder Healthhelp (utilization review): Consultant Google: Consultant Evidence-Based Neuroimaging Diagnosis and Treatment (Springer): Co-Editor ALL OTHER ATUHORS HAVE NO RELEVANT DISCLOSURES

Purpose  To describe initial 12-month usage of epidural steroid injections (ESI), facet injections, & facet medial branch radiofrequency ablations (RFA) in the Back pain Outcomes using Longitudinal Data (BOLD) registry.

Methods  This study included 4,612 of 5,239 total patients from the BOLD cohort that had complete 12-month electronic health record (EHR) data between 6/2011 and 6/2014.  BOLD is comprised of older adults (age ≥ 65 years) presenting for a new low back pain (LBP) episode from 3 integrated health systems.

Methods  Data sources: injections ascertained from the EHR & patient questionnaires (Roland-Morris Disability Questionnaire (RDQ), Brief Pain Inventory (BPI), Numerical Rating Scales (NRS) of average back & leg pain in past 7 days, Patient Health Questionnaire, (PHQ)-4 Depression & Anxiety screen, and the EQ5D).

Methods  Patients were assessed at baseline & 3, 6, and 12 months later. Occurrence of a procedure (ESI, Facet Injection, or RFA) was tabulated.  Logistic regression examined predictors of receiving an 1) ESI or 2) facet injection/RFA.  Covariates: age, gender, race, education, marital status, study site, symptom duration, back pain & health characteristics, & smoking status.

Results  Of 4,612 patients, there were 370 total injections received by 350 patients (mean procedures per patient 2.1, SD 1.6). Of those injections, 87.5% were ESI, 10.3% were facet injection, & 2.2% were RFA.

Results  Patients with longer symptom duration (1-5 years) (p=0.01) & those with leg pain or a leg pain diagnosis (p<0.001) are at higher risk of receiving an ESI but not facet injection/RFA.  Those with worse RDQ, back pain NRS, & BPI were at higher risk for receiving both ESI and facet injection/RFA (Figure 1).

Conclusions  BOLD registry patients tended to get ESI more often than facet injection or RFA.  Patients with worse baseline patient-reported outcomes were more likely to receive any procedure.  Patients with chronic leg pain were more likely to receive ESI, possibly reflecting the clinical indications for this procedure.

Reference  Jarvik JG, Comstock BA, Bresnahan BW, et al. Study protocol: the Back Pain Outcomes using Longitudinal Data (BOLD) registry. BMC Musculoskelet Disord. 2012;13:64.

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