Graham E. Wagner
· PM&R Spine Supervising FacultyVerifiedUniversity of Utah · Physical Therapy
Active 2010–2026
About
Graham E. Wagner, MD, is a physiatrist specializing in the care and treatment of painful spine and musculoskeletal conditions. He holds specialty board certification in Physical Medicine and Rehabilitation and subspecialty board certification in Pain Medicine. Dr. Wagner completed his residency in Physical Medicine and Rehabilitation at the University of Utah, where he served as chief resident, followed by a fellowship in Pain Medicine at Dartmouth. He works closely with patients to diagnose the source of their pain and to help them understand their treatment options, which range from conservative care with rehabilitation and exercise to interventional spinal procedures and neuromodulation. His overarching goal is to restore function and improve quality of life for his patients. Dr. Wagner collaborates with spine surgeons at the Department of Neurosurgery to ensure patients have access to a full spectrum of spine treatment options and receive the right treatment at the right time for the right reason. He currently serves on the Health Policy Division of the International Spine Intervention Society and the Health Policy Council of the North American Spine Society.
Research topics
- Medicine
- Internal medicine
- Psychiatry
- Anesthesia
- Physical therapy
- Emergency medicine
- Physical medicine and rehabilitation
- Pathology
- Family medicine
- Nursing
- Intensive care medicine
- Radiology
- Surgery
- Anatomy
Selected publications
Pain Medicine · 2026-03-27
articleOpen accessBACKGROUND: Radicular symptoms from lumbosacral spinal stenosis (LSS) are commonly managed with conservative measures, including transforaminal epidural steroid injection (TFESI). However, repeated use may cause systemic side effects in some patients. Human amniotic fluid filtrate (hAF), containing anti-inflammatory, neuroprotective, and regenerative factors, has shown therapeutic potential in pre-clinical models and other medical conditions. OBJECTIVES: Compare the safety and effectiveness of transforaminal epidural injections with hAF versus dexamethasone for treating radicular pain from LSS. DESIGN: Double-blinded, prospective, randomized comparative trial. METHODS: Fifty-eight participants were included, with outcomes assessed at 3 weeks, 6 weeks, 3 months (primary endpoint), and 6 months. Primary outcomes were adverse events (AEs) and proportions of participants reporting ≥50% numerical pain rating scale (NPRS) back and leg pain reductions at 3 months. Secondary outcomes included Oswestry Disability Index (ODI), Swiss Spinal Stenosis Questionnaire (SSSQ), and PROMIS Physical Health Summary (PHS). Linear mixed-effects models evaluated between-group differences while accounting for repeated measures. RESULTS: At 3 months, a significantly greater proportion of participants receiving dexamethasone achieved ≥50% reductions in back pain (45.8% [95%CI = 27.9-64.9%] vs. 15.0% [95%CI = 5.2-36.0%]; p = 0.050) and leg pain (60.0% [95%CI = 40.7-76.6%] vs. 25.0% [95%CI = 11.2-46.9%]; p = 0.034) compared with hAF. Secondary outcome trends similarly favored dexamethasone at 3 months. Mixed-effects models showed greater improvements to 6-week pain and function scores with dexamethasone relative to hAF. Group AE rates were comparable, and no serious intervention-related AEs occurred. CONCLUSION: Dexamethasone demonstrated significantly greater short- and intermediate-term benefits over hAF across multiple clinical outcome domains for radicular pain due to LSS, prompting early trial discontinuation.
Interventional Pain Medicine · 2025-01-01
articleOpen accessPain Medicine · 2025-08-30 · 7 citations
articleOpen accessSUMMARY OF BACKGROUND DATA: Multiple clinical trials have demonstrated the effectiveness of intraosseous basivertebral nerve radiofrequency ablation (BVNA) for treating chronic vertebrogenic low back pain (vLBP). Few studies have evaluated the effectiveness in a real-world population. OBJECTIVES: To evaluate the effectiveness of BVNA for vLBP in a real-world population. METHODS: A single-arm prospective cohort study of patients with LBP ≥ 6 months and Type 1 or Type 2 Modic changes on MRI. The primary outcome was mean improvement in Oswestry Disability Index (ODI) post-BVNA. Secondary outcomes included the proportion of participants with (1) ≥30% and ≥15-point ODI improvements, (2) ≥2-point and ≥50% reductions in pain on Numerical Rating Scale (NRS), and (3) ≥ "much improved" on Patient Global Impression of Change (PGIC) at 3- and 12-month follow-up. RESULTS: In total, 60 participants were included (mean age 57.0 ± 13.4 years; 45.0% female). Mean ODI score improvement was 13.9 ± 18.7 and 14.0 ± 15.7 points at 3- and 12-month follow-up, respectively. At 12 months, 52.8% (95% CI, 39.7-65.6) of participants reported ≥30% ODI improvement and 39.6% (95% CI, 27.6-53.1) of participants reported ≥15-point improvement in ODI. Twelve-month responder rates for ≥2-point and ≥50% NRS improvement were 67.9% (95% CI, 54.5-78.9) and 49.1% (95% CI, 36.1-62.1). Moreover, 54.7% (95% CI, 41.5-67.3) of participants reported being "much or very much improved" on the PGIC at 12 months. DISCUSSION/CONCLUSION: In this real-world cohort, over half of participants with vLBP experienced clinically meaningful improvements in pain and function at 12-month post-BVNA. TRIAL REGISTRATION DETAILS: ClinicalTrials.gov (original study: NCT04449835; continuation study: NCT05660512); [original study: June 25, 2020; continuation study: December 13, 2022].
Pain Medicine · 2023-08-11 · 16 citations
articleOpen accessBACKGROUND: Lumbar medial branch radiofrequency ablation (LRFA) and intraarticular facet steroid injections (FJI) are commonly performed for recalcitrant facet joint-mediated pain. However, no study has compared clinical outcomes of the two treatments in patients selected using dual medial branch blocks (MBBs) with an 80% relief threshold. OBJECTIVE: Compare the effectiveness of cooled LRFA (C-LRFA) to FIJ as assessed by pain and functional improvements. DESIGN: Prospective randomized comparative trial. METHODS: Patients with dual MBB-confirmed facet joint-mediated pain were randomized to receive C-LRFA or FIJ. Outcomes were assessed at 1, 3, 6, and 12 months. The primary outcome was ≥50% improvement in numerical pain rating scale (NPRS) score at 3 months. Secondary outcomes included ≥30% Oswestry Disability Index (ODI) improvement and Patient Global Impression of Chance (PGIC) ≥6 points, among others. Data were analyzed using contingency tables and mixed-effects logistic regression models. RESULTS: Of 1128 patients screened, 32 met eligibility criteria, were randomized, and received their allocated study treatment. In total, 20 (62.5%) and 12 (37.5%) participants received C-LRFA and FIJ, respectively. In the C-LRFA group, 70% (95% CI 48-85), 55% (95% CI 34-74), and 45% (95% CI 26-66) of participants met the NPRS responder definition, compared to 25% (95%CI 9-53), 25% (95% CI 9-53), and 17% (95% CI 5-45) in the FJI group at 3, 6, and 12 months, respectively (P = .014 at 3 months). The PGIC responder proportion was higher in the C-LRFA compared to FJI group at 3 and 6 months (P < .05). CONCLUSIONS: C-LRFA demonstrated superior success rates compared to FJI across pain and functional outcome domains. TRIAL REGISTRATION DETAILS: ClinicalTrials.gov (NCT03614793); August 3, 2018.
Interventional Pain Medicine · 2023-01-01 · 1 citations
articleOpen accessInterventional Pain Medicine · 2023-01-01
articleOpen accessRadiofrequency Ablation for Chronic Posterior Sacroiliac Joint Complex Pain: A Comprehensive Review
Pain Medicine · 2021 · 25 citations
- Medicine
- Radiology
- Anatomy
Radiofrequency ablation of the sacral lateral branches targets the innervation of the posterior sacroiliac ligaments and posterior portion of the sacroiliac joint. These structures are also collectively referred to as the posterior sacroiliac joint complex. This review will discuss current diagnostic block paradigms and selection criteria for sacral lateral branch radiofrequency ablation, varying techniques and technologies utilized for sacral lateral branch radiofrequency ablation, and updates on the clinical outcome literature. The current evidence suggests that sacral lateral branch radiofrequency ablation can provide relief for posterior sacroiliac joint complex pain, but the literature is limited by variability in selection criteria, the specific nerves targeted by radiofrequency ablation, and the types of radiofrequency ablation technology and techniques utilized in clinical outcome studies.
Interventional Pain Medicine · 2021-12-16 · 5 citations
articleOpen accessBackground: Thoracic transforaminal epidural steroid injections (TFESIs) are procedures performed for the treatment of thoracic spine pain (TSP). The literature on these interventions is sparse. Purpose: To report outcomes of thoracic TFESIs for TSP indications. Study design: Multicenter, retrospective, cross-sectional cohort study. Patient sample: Consecutive patients receiving thoracic TFESIs at three academic spine centers. Outcome measures: The primary outcome was the proportion of patients reporting at least 50% improvement in NRS pain score at short-term follow-up (>1 week, <3 months post-injection). Methods: A chart review was performed of consecutive patients who underwent a thoracic TFESI over a 4- to 10-year time period at three academic spine centers and had reported an NRS pain score at short-term follow-up. Results: Overall, 19/64 patients (30% [95% CI 20-42%]) experienced ≥50% relief following the injection at a median 22 days follow-up. 42% [95% CI 31-54%] experienced at least a 2-point improvement in NRS score. There was a slight improvement in median NRS scores from pre-to post-procedure of -1 (IQR -3, 0), from 6/10 to 5/10 (p < 0.001). The success rate (≥50% pain relief) was 36% [95%CI 22-52%] in those with a disc herniation as compared to 21% [95%CI 10-40%]) in those with degenerative stenosis; however, the difference did not reach statistical significance. There was a trend towards a greater success rate in those who were employed vs. unemployed (43% [95% CI 27-61%] vs. 19% [95% CI 9-36%]). Conclusions: This is the largest series reporting outcomes from thoracic TFESI to date. Overall, the observed success rate was low compared to known success rates associated with TFESI for the treatment of pain at cervical and lumbar spinal regions.
Pain Medicine · 2020 · 19 citations
- Medicine
- Physical therapy
- Physical medicine and rehabilitation
OBJECTIVE: Determine the effectiveness of spinal cord stimulation (SCS) for the treatment of axial low back pain (LBP) with or without leg pain. DESIGN: Systematic review. SUBJECTS: Persons aged ≥18 with axial LBP with or without accompanying leg pain. INTERVENTION: Traditional low-frequency, burst, or high-frequency SCS. COMPARISON: Sham, active standard of care treatment, or none. OUTCOMES: The primary outcome was ≥50% pain improvement, and the secondary outcome was functional improvement measured six or more months after treatment intervention. METHODS: Publications in PubMed, MEDLINE, and Cochrane databases were reviewed through September 19, 2019. Randomized or nonrandomized comparative studies and nonrandomized studies without internal controls were included. The Cochrane Risk of Bias Tool and GRADE system were used to assess individual study characteristics and overall quality. RESULTS: Query identified 262 publications; 17 were suitable for inclusion. For high-frequency SCS, the only level 1 study showed that 79% (95% confidence interval = 70-87%) of patients reported ≥50% pain improvement. For low-frequency SCS, the only level 1 study reported no categorical data for axial LBP-specific outcomes; axial LBP improved by a mean 14 mm on the visual analog scale at six months. Meta-analysis was not performed due to study heterogeneity. CONCLUSIONS: According to GRADE, there is low-quality evidence that high-frequency SCS compared with low-frequency SCS is effective in patients with axial LBP with concomitant leg pain. There is very low-quality evidence for low-frequency SCS for the treatment of axial LBP in patients with concomitant leg pain. There is insufficient evidence addressing the effectiveness of burst SCS to apply a GRADE rating.
Pain Medicine · 2020 · 19 citations
- Medicine
- Family medicine
- Emergency medicine
BACKGROUND AND OBJECTIVES: The novel coronavirus outbreak (SARS-CoV-2) began in late 2019 and dramatically impacted health care systems. This study aimed to describe the impact of the early phase of the pandemic on physician decision-making, practice patterns, and mental health. METHODS: An anonymous survey was distributed to physician members of the Spine Intervention Society (SIS) on March 24 and April 7, 2020. Respondents provided information regarding changes in clinical volume, treatment, and mental health (Patient Health Questionnaire [PHQ-4]) before April 10, 2020. RESULTS: Of the 1,430 individuals who opened the survey, 260 completed it (18.2%). Overall clinical and procedural volume decreased to 69.6% and 13.0% of prepandemic volume, respectively. Mean in-person clinic visits were reduced to 17.7% of total prepandemic clinic volume. Ongoing clinical visits were predominantly completed via telemedicine (video) or telephone (74.5%), rather than in-person (25.5%). Telemedicine and telephone visits represented 24.6% and 27.3% of prepandemic clinical volume, respectively. Respondents decreased in-person visits of select groups of high-risk patients by 85.8-94.6%. Significantly more providers reported increasing rather than decreasing prescriptions of the following medications: opioids (28.8% vs 6.2% of providers, P < 0.001), muscle relaxants (22.3% vs 5.4%, P < 0.001), neuropathic pain medications (29.6% vs 3.8%, P < 0.001), and acetaminophen (26.2% vs 4.2%, P < 0.001). Respondents' mean PHQ-4 score was 3.1, with 19% reporting moderate or severe psychological distress. Several demographic factors were significantly associated with practice changes. CONCLUSIONS: The novel coronavirus pandemic dramatically altered the practice and prescribing patterns of interventional pain physicians.
Frequent coauthors
- 11 shared
Masaru Teramoto
University of Utah
- 8 shared
Stuart E. Willick
University of Utah
- 5 shared
Zachary L. McCormick
University of Utah
- 4 shared
David J. Kennedy
Foundation for Physical Medicine and Rehabilitation
- 4 shared
Aaron Conger
University of Utah
- 4 shared
Carolyn A. Emery
Alberta Children's Hospital
- 3 shared
Taylor Burnham
University of Utah
- 3 shared
George Josten
Education
M.D.
University of Utah
Other, Physical Medicine and Rehabilitation
University of Utah
Other, Pain Medicine
Dartmouth
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