Benefits of the Various Pain Procedures as Therapeutic Option in Low Back Pain

  • Published : 2006.03.30

Abstract

Objective : The authors retrospectively evaluate the benefits of the various pain procedures for the treatment of low back pain unresponsive to conservative management. Methods : Over a period of 2 years from May 2002 and June 2004, the authors had performed various pain procedures on 106 patients with low back pain. Epidural block, facet joint block, sacroiliac joint block, and myofascial block were included among various pain procedures. The pain improvement, period of analgesic use, and degree of satisfaction were evaluated 1 day, 4 weeks, and 6 months after injections. The outcome of pain procedures was analyzed by using a modified Macnab criteria. Results : Sixty-four patients had a single procedure with no combination and 42 patients [39.6%] received the combination of the various pain procedure. Regardless of the single or combination cases of procedure, combination of appropriate spinal level on each procedure was conducted in 104 [98.1%]. Mean follow up period was 12.2 months. Eighty-two patients [77.4%] experienced significant pain relief and overall analgesic medication was reduced in 91 patients [85.8%] at 6 months after procedure. Unfavorable results were demonstrated in 10 patients. Permanent procedural complications did not occur. Conclusion : The various pain procedures are the possible therapeutic option for low back pain unresponsive to conservative management including medication or physical therapy.

Keywords

References

  1. Bani A, Spetzger U, Gilsbach JM : Indication for and benefits of lumbar facet joint block : analysis of 230 consecutive patients. Neurosurg Focus 13 : 1-5, 2002
  2. Broadman LM, Navalgund YA, Hawkinberry II DW : Radiation risk management during fluoroscopy for international pain medicine physicians. Curr Pain Headache Rep 8 : 49-55, 2004 https://doi.org/10.1007/s11916-004-0040-x
  3. Cavanaugh JM, Ozaktay AC, Yamashita HT : Mechanism of low back pain : a neurophysiologic and neuroanatomic study. Clin Orthop 335 : 166-180, 1997
  4. Cavanaugh JM, Ozaktay AC, Yamashita HT, King A : Lumbar facet pain : biomechanics, neuroanatomy and neurophysiology. J Biomech 29 : 1117-1129, 1996 https://doi.org/10.1016/0021-9290(96)00023-1
  5. Cocicov AF, Cocicov HLF : Epidural steroids for low back pain syndromes. Rev Bras Anesthesiol 54 : 129-141, 2004 https://doi.org/10.1590/S0034-70942004000100017
  6. El-Khoury GY, Renfrew DL : Percutaneous procedures for the diagnosis and treatment of lower back pain : Diskography, facet-joint injection, and epidural injection. AJR 157 : 685-691, 1991 https://doi.org/10.2214/ajr.157.4.1832511
  7. Joy H, Ha SK, Kim SH, Lim DJ, Park JY, Suh JK : Prognostic factors of percutaneous radiofrequency neurotomy on the posterior primary ramus. J Korean Neurosurg Soc 33 : 51-55, 2003
  8. Kwon YJ, Choi CS : The neural blockades for low back pain and radicular pain in patients. J Korean Neurosurg Soc 33 : 271-275, 2003
  9. Lee TH, Yoon YS, Chin DK, Cho YE, Kim YS : The effect of combined nerve block for low back pain. J Korean Neurosurg Soc 34 : 110-114, 2003
  10. Lippitt AB : The facet joint and its role in spine pain management with facet joint injections. Spine 9 : 746-750, 1984 https://doi.org/10.1097/00007632-198410000-00016
  11. Lynch MC, Taylor JF : Facet joint injection for low back pain. A clinical study. J Bone Joint Surg 68A : 138-141, 1986
  12. Macnab I : Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg 53A : 891-903, 1971
  13. Nelson DA, Landau WM : Intraspinal steroids : history, efficacy, accidentally, and controversy with review of United States Food and Drug Administration reports. J Neurol Neurosurg Psychiatry 70 : 433-443, 2001 https://doi.org/10.1136/jnnp.70.4.433
  14. Park DH, Lee JH, Park JY, Kim SH, Lim DJ, Lee KC : Role of nerve block and radiofrequency treatment in management of chronic refractory spinal pain in elderly patients. Pain 12 : 84-94, 2002
  15. Purcell-Jones G, Pither CE, Justins DM : Paravertebral somatic nerve block : a clinical, radiographic, and computed tomograghic study in chronic pain patients. Anesth Analg 68 : 32-39, 1989
  16. Revel M, Poiraudeau S, Auleley GR, Payan C, Denke A, Nguyen M, et al : Capacity of the clinical picture to characterize low back pain relieved by facet joint anesthesia Proposed criteria to identify patients with painful facet joints. Spine 23 : 1972-1977, 1998 https://doi.org/10.1097/00007632-199809150-00011
  17. Salerni AA : A minimally invasive approach for posterior lumbar interbody fusion. Neurosurg Focus 13 : 15, 2002
  18. Tae HS, Kim SD, Park JY, Kim SH, Lim DJ, Suh JK : Gray ramus communicans nerve block : a useful therapeutic adjuvant for painful osteoporotic vertebral compression fracture. J Korean Neurosurg Soc 34 : 505-508, 2004
  19. Tremains MR, Greorgiadis GM, Dennis MJ : Radiation exposure with use of the inverted-c-arm technique in upper extremity surgery. J Bone Joint Surg 83A : 674-678, 2001