The Dilemma of Chronic Low Back Pain

Almost everyone has episodes of low back pain (LBP) from time to time. Fortunately, most episodes of LBP are considered acute, and resolve within 6 to 12 weeks. When LBP pain persists and becomes chronic, treatment is considerably more complicated and often leads the patient to the surgical suite.

Researchers from Case Western Reserve University and the Veterans Affairs Medical Center in Cleveland, Ohio, acknowledge that treating Chronic LBP patients successfully is dependent on a multifaceted, interdisciplinary approach. They have published a narrative review in the November issue of Neuromodulation that expands on the traditional treatments (physical therapy, psychosocial interventions, pharmacologic management) to include interventional pain procedures to treat and diagnosis chronic LBP.

The reason for the review is simple: Researchers understanding LPB’s pathophysiology better than ever before, but patients’ functional outcomes remain unchanged. The authors propose that interventional pain management modalities could be a useful component in multimodal treatment of chronic LBP. This is particularly true when diagnostic procedures are used to complement medical decision making and confirm suspected diagnoses.

The authors cover a full range of considerations (rationales, indications, technique, evidence, and complications) for many interventional procedures (ie, nerve blocks, epidural steroid injections, radiofrequency ablation, intradiscal procedures, vertebral augmentation procedures [vertebroplasty/kyphoplasty], spinal cord stimulation, and intrathecal drug delivery with an implantable pump). In addition, they provide information to help surgeons formulate a prognosis after some interventional treatments.

Their key point is that interventional pain management techniques may alter the course of the disease when employed to facilitate active rehabilitation. They report that based on evidence, it appears that some interventional pain medicine procedures have better risk-benefit and cost-effectiveness ratios than spine surgery.

The authors present ample evidence that documents safety, efficacy, and cost-effectiveness in treating LBP for spinal cord stimulation, medical branch blocks and radiofrequency ablations, and epidural steroid injections for radiculopathy. They also cover interventions that have lead to only modest functional improvements.