Association of Protein and Genetic Biomarkers with Response to Lumbar Epidural Steroid Injections in Subjects with Axial Low Back Pain

Stephen Schaaf, Wan Huang, Subashan Perera, Yvette Conley, Inna Belfer, Prakash Jayabalan, Katie Tremont, Paulo Coelho, Sara Ernst, Megan Cortazzo, Debra Weiner, Nam Vo, James Kang, Gwendolyn Sowa*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objective The purpose of this observational study was to examine the association of protein and genetic biomarkers with pain and pain-related disability in individuals with axial low back pain undergoing epidural steroid injections. Design Forty-eight adults with axial low back pain undergoing an epidural steroid injection were recruited from an academic medical center. Blood samples were assayed at baseline and follow-up for plasma proteins and functional single-nucleotide polymorphisms associated with pain. Data regarding pain and function were collected at baseline and follow-up. The characteristics of responders (defined as 50% improvement in pain score) and nonresponders were compared, and the association between response and baseline biomarkers was examined. Results Thirty-five percent of subjects were responders to injection. Responders had lower baseline plasma levels of chondroitin sulfate 846 and higher neuropeptide Y and serotonin levels than nonresponders, and baseline neuropeptide Y level correlated with change in disability levels. In addition, subjects with the variant allele for the catechol-O-methyltransferase single-nucleotide polymorphism demonstrated increased odds of responding to the injection. Conclusions These data identify candidates who may have utility for patient selection for spinal procedures and provide support for exploration in prospective studies to assess and validate their predictive ability.

Original languageEnglish (US)
Pages (from-to)48-56
Number of pages9
JournalAmerican Journal of Physical Medicine and Rehabilitation
Issue number1
StatePublished - 2021


  • Biomarker
  • Epidural
  • Low Back Pain
  • Spine

ASJC Scopus subject areas

  • Medicine(all)


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