Journal List > J Korean Med Assoc > v.55(6) > 1042583

Ko and Kim: Interventional therapy for chronic low back pain

Abstract

Chronic low back pain has become a major public health problem in Korea. The lifetime prevalence of low back pain has been reported to be as high as 90%. The prevalences of discogenic pain, facet joint pain, and sacroiliac joint pain are 42%, 30%, and 18%, respectively. Increasing age is associated with a decreasing probability of discogenic pain but increasing probabilities of facet joint pain and sacroiliac joint pain as the source of low back pain. Physical examination of low back pain is limited and imaging may lack objective clues. Diagnostic interventions allow us to determine the etiology of back pain. Techniques include lumbar disc stimulation, facet joint block, medial branch block, and sacroilliac joint block. Initial therapy includes modification of activity, pharmacological analgesic therapy, and education of patients. In patients with chronic low back pain, a multimodal and interdisciplinary treatment approach is necessary. Use of interventional treatments for chronic low back pain are increasing but their utilization remains uncertain or controversial. Therefore, management of patients with chronic and disabling low back pain remains a clinical challenge.

Figures and Tables

Table 1
"Red flag" indication of serious spinal pathology
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Table 2
Discography endpoints
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VAS, visual analogue pain score.

Table 3
Gradation of the radial fissures visible on CT discography (Dallas scale)
jkma-55-562-i003

CT, computed tomography.

References

1. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G. COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006. 15:Suppl 2. S192–S300.
2. Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999. 354:581–585.
3. Nicholas MK, Linton SJ, Watson PJ, Main CJ. "Decade of the Flags" Working Group. Early identifica-tion and management of psychological risk factors ("yellow flags") in patients with low back pain: a reappraisal. Phys Ther. 2011. 91:737–753.
4. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J. 2010. 10:514–529.
5. Choi YS, Cho WJ, Yun SH, Lee SY, Park SH, Park JC, Jang EH, Shin HY. A case of back pain caused by Salmonella spondylitis: a case report. Korean J Anesthesiol. 2010. 59:Suppl. S233–S237.
6. DePalma MJ, Ketchum JM, Saullo T. What is the source of chronic low back pain and does age play a role? Pain Med. 2011. 12:224–233.
7. Wolfer LR, Derby R, Lee JE, Lee SH. Systematic review of lumbar provocation discography in asymptomatic subjects with a meta-analysis of false-positive rates. Pain Physician. 2008. 11:513–538.
8. Peng B, Wu W, Hou S, Li P, Zhang C, Yang Y. The pathogenesis of discogenic low back pain. J Bone Joint Surg Br. 2005. 87:62–67.
9. Vanharanta H, Sachs BL, Spivey MA, Guyer RD, Hochschuler SH, Rashbaum RF, Johnson RG, Ohnmeiss D, Mooney V. The relationship of pain provocation to lumbar disc deterioration as seen by CT/discography. Spine (Phila Pa 1976). 1987. 12:295–298.
10. Sachs BL, Vanharanta H, Spivey MA, Guyer RD, Videman T, Rashbaum RF, Johnson RG, Hochschuler SH, Mooney V. Dallas discogram description: a new classification of CT/discography in low-back disorders. Spine (Phila Pa 1976). 1987. 12:287–294.
11. Carragee EJ, Don AS, Hurwitz EL, Cuellar JM, Carrino JA, Herzog R. 2009 ISSLS prize winner: does discography cause accelerated progression of degeneration changes in the lumbar disc: a ten-year matched cohort study. Spine (Phila Pa 1976). 2009. 34:2338–2345.
12. Indahl A, Kaigle AM, Reikeras O, Holm SH. Interaction between the porcine lumbar intervertebral disc, zygapophysial joints, and paraspinal muscles. Spine (Phila Pa 1976). 1997. 22:2834–2840.
13. Simmons JW, McMillin JN, Emery SF, Kimmich SJ. Intradiscal steroids: a prospective double-blind clinical trial. Spine (Phila Pa 1976). 1992. 17:6 Suppl. S172–S175.
14. Khot A, Bowditch M, Powell J, Sharp D. The use of intradiscal steroid therapy for lumbar spinal discogenic pain: a randomized controlled trial. Spine (Phila Pa 1976). 2004. 29:833–836.
15. Klein RG, Eek BC, O'Neill CW, Elin C, Mooney V, Derby RR. Biochemical injection treatment for discogenic low back pain: a pilot study. Spine J. 2003. 3:220–226.
16. Assietti R, Morosi M, Migliaccio G, Meani L, Block JE. Treatment of discogenic low back pain with Intradiscal Electrothermal Therapy (IDET): 24 months follow-up in 50 consecutive patients. Acta Neurochir Suppl. 2011. 108:103–105.
17. Appleby D, Andersson G, Totta M. Meta-analysis of the efficacy and safety of intradiscal electrothermal therapy (IDET). Pain Med. 2006. 7:308–316.
18. Karaman H, Tufek A, Kavak Go, Kaya S, Yildirim ZB, Uysal E, Celik F. 6-Month results of transDiscal biacuplasty on patients with discogenic low back pain: preliminary findings. Int J Med Sci. 2010. 8:1–8.
19. Erdine S, Yucel A, Celik M. Percutaneous annuloplasty in the treatment of discogenic pain: retrospective evaluation of one year follow-up. Agri. 2004. 16:41–47.
20. Jang JS, Kwon HK, Lee JJ, Hwang SM, Lim SY. Rami communicans nerve block for the treatment of symptomatic schmorl's nodes: a case report. Korean J Pain. 2010. 23:262–265.
21. Oh WS, Shim JC. A randomized controlled trial of radiofrequency denervation of the ramus communicans nerve for chronic discogenic low back pain. Clin J Pain. 2004. 20:55–60.
22. Kallewaard JW, Terheggen MA, Groen GJ, Sluijter ME, Derby R, Kapural L, Mekhail N, van Kleef M. 15. Discogenic low back pain. Pain Pract. 2010. 10:560–579.
23. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L. American Society of Interventional Pain Physicians. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician. 2007. 10:7–111.
24. Cohen SP, Williams KA, Kurihara C, Nguyen C, Shields C, Kim P, Griffith SR, Larkin TM, Crooks M, Williams N, Morlando B, Strassels SA. Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch (facet joint nerve) block treatment paradigms before lumbar facet radiofrequency denervation. Anesthesiology. 2010. 113:395–405.
25. Carette S, Marcoux S, Truchon R, Grondin C, Gagnon J, Allard Y, Latulippe M. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. N Engl J Med. 1991. 325:1002–1007.
26. Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine (Phila Pa 1976). 2000. 25:1270–1277.
27. Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A. Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study. Br J Rheumatol. 1996. 35:767–770.
28. Patel N, Gross A, Brown L, Gekht G. A randomized, placebo-controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain. Pain Med. 2012. 13:383–398.
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