Interventional therapy for chronic low back pain

Youngkwon Ko; Yoon Hee Kim

doi:10.5124/jkma.2012.55.6.562

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

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Ko and Kim: Interventional therapy for chronic low back pain

Continuing Education Column

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2012; 55(6): 562-570.

Published online: 14 June 2012

DOI: https://doi.org/10.5124/jkma.2012.55.6.562

Interventional therapy for chronic low back pain

Youngkwon Ko, MD, Yoon Hee Kim, MD

Department of Anesthesiology and Pain Medicine, Chungnam National University School of Medicine, Deajeon, Korea.

Corresponding author: Yoon Hee Kim, yhkim0404@cnu.ac.kr

Received 12 April 2012 Accepted 26 April 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Lower back pain, Pain management, Intervertebral disk, Zygapophyseal joint, Sacroiliac joint

Figures and Tables

Table 1

"Red flag" indication of serious spinal pathology

Table 2

Discography endpoints

VAS, visual analogue pain score.

Table 3

Gradation of the radial fissures visible on CT discography (Dallas scale)

CT, computed tomography.

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