Figure 13 - uploaded by Farnad Imani
Content may be subject to copyright.
Source publication
Context:
Lower back pain is considered to be one of the most common complaints that brings a patient to a pain specialist. Several modalities in interventional pain management are known to be helpful to a patient with chronic low back pain. Proper diagnosis is required for appropriate intervention to provide optimal benefits. From simple trigger p...
Similar publications
Background: Radiofrequency neurotomy (RFN) is a therapy aimed at providing lasting back pain relief for sacroiliac joint (SIJ) pain. A recent advancement in RFN is a strip lesioning technique that involves placement of a single curved electrode and a 3-pole design that facilitates the creation of 5 overlapping lesions. These lesions form one long s...
Citations
... While no consensus has been reached on the most suitable radiological guidance [33,34], fluoroscopy is the oldest and most documented approach. When an intraarticular radiological-guided injection approach is chosen, the literature suggests performing the injection in the lower third of the joint [35]. However, more recently ultrasound is gaining attention as a valid alternative to fluoroscopically and TCguided injections, with similar treatment effect but lower radiations to the patients and to the practitioners, as well as for the capacity to avoid critical vessel injuries [10]. ...
Background
The most effective injective treatment approach for sacroiliac joint (SIJ) pain remains unclear. Aim of this study was to quantify the safety and effectiveness of the available injective strategies to address SIJ pain.
Methods
A systematic review and meta-analysis of the literature was conducted on PubMed, Scopus, and Embase databases from inception until January 2023. Inclusion criteria were studies written in English, comparative and non-comparative studies regardless of the minimum follow-up, and case series on SIJ injections. Safety and efficacy of the different injection therapies for the SIJ were quantified. A meta-analysis was conducted on the available data of the documented injective therapies. The “Checklist for Measuring Quality” by Downs and Black was used to assess the risk of bias and the quality of papers.
Results
The literature search retrieved 43 papers (2431 patients): 16 retrospective case series, 2 retrospective comparative studies, 17 prospective case series, 3 prospective comparative studies, and 5 randomized controlled trials. Of the selected studies, 63% examined the effect of steroid injections, 16% of PRP injections, while 21% reported other heterogeneous treatments. The failure rate was 26% in steroid injections and 14% in PRP injections. The meta-analysis showed a statistically significant reduction in pain with the VAS score for both steroids and PRP: steroids improvement at mid-term 3.4 points ( p < 0.05), at long-term 3.0 ( p < 0.05), PRP improvement at mid-term 2.2 ( p = 0.007), at long-term 2.3 points of the VAS pain scale ( p = 0.02).
Conclusions
Steroids are the most documented injective approach, with studies showing an overall safety and effectiveness. Still, the high number of failures underlined by some studies suggest the need for alternative procedures. Early PRP data showed promise, but the limitations of the current literature do not allow to clearly define the most suitable injective approach, and further studies are needed to identify the best injective treatment for SIJ patients.
... Микроразрывы фиброзного кольца и прорастание рецепторов через его задние отделы считаются одним из значимых факторов патогенеза дискогенной боли; методы радиочастотной аннулопластики направлены на коагуляцию коллагена и стабилизацию стенки диска, термоабляцию нервных окончаний с денервацией диска [17]. Основным показанием к выполнению вмешательств является дискогенный болевой синдром, обусловленный протрузией диска и/или подтвержденный при провокационной дискографии [17][18][19]. На рис. [20]. ...
Low back pain (lumbar pain) is one of the most common causes of disability in the population. In cases where conservative treatment of discogenic or musculoskeletal low back pain does not have a positive effect, interventional methods of diagnosis and treatment are used, which are developing actively on the background of rapid technological progress. Being on the border of interdisciplinary interaction, interventional methods can significantly shorten the duration of conservative therapy and, in many cases, avoid surgical decompressive interventions, which are associated with a considerable risk of complications. The methods, efficacy and safety of epidural administration of glucocorticoids for discogenic radiculopathy and lumbar stenosis as well as the methods of radiofrequency denervation for musculoskeletal pain due to the facet joints and the sacroiliac joint involvement are discussed. The possibilities of drug therapy for musculoskeletal pain of the lumbar spine, and combination of non-steroidal anti-inflammatory drugs and a vitamin B complex, are discussed.
... Low back pain is the second most common reason for visiting a doctor after a cold (1). Approximately 80% of people experience it at least once in their lifetime (2). The rate of disability due to low back pain has increased by 54% from 1990 to 2015 (3). ...
... The rate of disability due to low back pain has increased by 54% from 1990 to 2015 (3). Almost 10% of patients with low back pain have specific symptoms with a known cause, such as spondylolisthesis, lumbar spinal stenosis, fracture of the spine, nerve root compression, or inflammatory disease (2). However, 90% of these patients are diagnosed without specific symptoms, known as non-specific chronic low back pain (NSCLBP), where the cause of the disease cannot be identified clinically (4). ...
Background: Non-specific chronic low back pain (NSCLBP) is a prevalent condition that affects 90% of individuals experiencing low back pain. Core stabilization exercises (CSE) stand out as the most commonly employed therapeutic approach for managing NSCLBP. Nevertheless, there remains uncertainty regarding the superior effectiveness between isometric (ISOM) and isotonic (ISOT) types of CSE in the treatment of NSCLBP.
Objectives: The primary objective of this study was to compare the efficacy of ISOM and ISOT exercises concerning pain and disability in patients with NSCLBP. Additionally, the study aimed to assess the effectiveness of both ISOM and ISOT in comparison to no intervention concerning these variables in these patients.
Methods: This study was a randomized controlled trial that involved 41 men and women experiencing NSCLBP. Participants were randomly allocated to three groups: ISOM CSE (n = 13), ISOT CSE (n = 14), and a waitlist control (n = 14). The exercise training was administered for 40-60 minutes three times a week over a period of up to 8 weeks. Pain (assessed using the Visual Analog Scale or VAS) and disability (evaluated through the Oswestry Disability Index or ODI) variables were measured before and after the interventions.
Results: Based on the results, there was no significant difference between the 2 exercise groups (ISOM and ISOT) regarding pain and disability. However, the ISOM group demonstrated numerically better results than the ISOT group. Both the ISOM and ISOT groups exhibited a significant decrease in pain levels, with the VAS score decreasing from 5.5 to 2.7 for ISOM and from 5.8 to 3.7 for ISOT, as compared to the control group (P < 0.001 and P = 0.001, respectively). Additionally, the average disability showed a significant improvement in both the ISOM (ODI score from 17 to 11) and ISOT (ODI score from 15.4 to 11) groups compared to the control group (P < 0.001).
Conclusions: Both ISOM and ISOT methods are effective in alleviating pain and disability in patients with NSCLBP. However, there is no significant difference in the benefits between them. Numerically, ISOM exercises were found to be superior. Further studies are needed to obtain a more accurate answer regarding their superiority.
... Low back pain is one of the most commonly reported problems in pain medicine with a lifetime prevalence of 65% to 80% [1][2][3]. Patients with low back pain experience decreased quality of life and high rates of disability [2]. Consequently, low back pain is the top cause of worldwide productivity loss [2]. ...
... The effectiveness of steroid injections relies on the precise delivery of the steroid to the ventral nerve root in the epidural space [5,6]. There are multiple approaches to enter the epidural space under fluoroscopic guidance, including interlaminar, caudal, and transforaminal [3,6]. Transforaminal epidural steroid injections (TFESIs) are the most commonly used option and considered more efficacious than a caudal or interlaminar approach for treating radicular pain, likely due to the TFESI's needle tip placement resulting in better ventral spread of medication during injection [6][7][8]. ...
... The TFESI procedure involves directing a spinal needle posterolateral to the epidural space at the outer border of the intervertebral foramen, often under fluoroscopic guidance [3,13]. Corticosteroids are then injected into the epidural space immediately adjacent to the exiting nerve root to reduce inflammation and alleviate radicular symptoms. ...
Background
Transforaminal epidural steroid injections (TFESIs) are widely used as a minimally invasive treatment for lumbar radicular pain. This study presents an alternative approach for lumbar TFESI, the Kumar Technique, which utilizes a more lateral and inferior needle starting point to better align the trajectory of the needle with the neural foramen. We hypothesize the Kumar Technique will result in safer and more effective outcomes than the traditional approach to TFESI. This article was previously presented as a poster at the 2023 University of Florida College of Medicine Celebration of Research on February 27-28, 2023, and as an abstract and poster at the 2023 University of Florida Department of Anesthesiology Celebration of Research on March 29, 2023.
Methods
The charts for 1,424 patients who received lumbar TFESIs were retrospectively reviewed, and patients were stratified into groups receiving either the traditional approach or the Kumar Technique. Outcomes measures included numerical pain scores, measures of functional status and activity limitations, duration of pain relief, and procedural complications.
Results
Compared to the group undergoing the traditional approach, patients receiving the Kumar Technique reported a significantly greater decrease in average pain (-2.3 (95% CI: -3.0 to -1.6) vs -1.1 (95% CI: -1.4 to -0.7)) and maximum pain (-2.4 (95% CI: -3.2 to -1.6) vs -1.3 (95% CI: -1.8 to -0.9)). Patients receiving the Kumar Technique had a significantly greater likelihood of reporting any pain relief (OR: 2.10, 95% CI:1.59 to 2.79) compared to those undergoing the traditional approach. In addition, a greater percentage of patients receiving the Kumar Technique experienced at least one month of pain relief compared to the traditional approach (54% vs 40%; z = 3.85, p < 0.001). The occurrence of complications did not significantly vary between the modified (4.1%) and the traditional (3.0%) approaches.
Conclusions
The Kumar Technique is a modified TFESI approach that allows for improved access to the nerve roots through a more lateral and inferior needle entry point. The analysis supports the benefits of the Kumar Technique with patients experiencing a greater reduction in pain and longer durations of pain relief without increasing the risk of complications.
... Medication, nerve blocks, and spinal cord stimulation are all examples of pain management techniques. Physical therapy can increase mobility and decrease discomfort 14 . In some circumstances, additional surgery may be required to treat underlying cause of PSSS. ...
Background: Post spinal surgery syndrome (PSSS) is characterized by chronic discomforts post one or more spine operations. Despite advancements in surgical technology, failure rate of back operations has not decreased. These conditions may occur preoperatively, intraoperatively, and postoperatively. Objectives: The primary purpose of this investigation was to ascertain the incidence and causes of neurological complications in patients who have undergone spinal surgery and subsequently developed PSSS. Methods: Cross sectional research was performed at Mardan Medical Complex, Mardan, comprising 82 patients (50 males and 32 females). X-ray studies, MRI, and electromyography was the tool for initial lumbar surgery to confirm the initial diagnosis. Participants were requested to submit the questionnaire and then, their scores were calculated and analyzed as per standard protocols. Results: The potential causes of PSSS, indicated 16 (19.5%) patients with incorrect diagnosis, 24 (29.3%) of the due to surgical technical errors, 10 (12.2%) due to improper pre-operative patient selection and 20 (24.4%) as a result of recurrent disc herniation after surgery. The frequency of cases of complications was spinal fusion (64.09%), followed by kinesiophobia (47.38%), laminectomy (45.98%), depression (40.3%), numbness in lower limbs (36.9%), myelopathy (14.5%) and other neurological deficits (12.56%).
... (Botox) The affected muscle is injected at various tender points as identified by palpation followed by stretching exercises to achieve long-term relief of pain. Dry needling is used by some practitioners and found equally effective when combined with physical therapy [65]. a. Interlaminar epidural injection This is the most common procedure performed blind; however, fluoroscopic guidance is recommended to ensure the correct level and side and avoid intra-arterial injections. ...
... The needle targets the inferior portion of the intervertebral foramen and medication (steroids/local anaesthetic) is delivered after fluoroscopic confirmation. Manchikanti suggested that the evidence in favour of therapeutic transforaminal steroid epidural injection in managing chronic low back pain is less controversial and more balanced than diagnostic blocks and blind interlaminar epidural injections [65,68]. ...
... An epidural needle is used via a midline approach to access sacral epidural space, halted at the S3 level to avoid penetration of the dura, which usually extends up to the S2 level but can be lower. After fluoroscopic confirmation of position using contrast, the corticosteroid can be injected [65]. ...
Background
Chronic neck and back pain are among the most commonly encountered health problems in neurosurgical practice. Many cases fail prolonged pharmacological and physical therapy and are not proper candidates for surgical interventions, or had refused proposed surgical treatment.
Objective
To provide an informative critical summary of the literature about the topic of interventional management of axial neck and low back pain and highlighting the new trends and pieces of evidence.
Methods
The English literature published over the last two decades was reviewed by the author for recent and relevant data about the principles of interventional management of chronic neck and low back pain. A PubMed search was performed through phrase searching and combined searching using Boolean operators. The articles thought to be most relevant to the study aim and the neurosurgeons’ practice were extracted.
Results
Neck and low back pain continue to be among the most common musculoskeletal health problems and the most common cause of disability worldwide. A detailed understanding of relevant spine anatomy is crucial for interventionists who should deal with the concept of “functional spine unit” with multiple potential pain generators. Chronic spinal pain is best managed through a dedicated multidisciplinary team in well-equipped healthcare facilities. An algorithmic approach for the diagnosis and management of spinal pain is the mainstay of providing the best patient care and should be based on the commonality and treatability of pain generators, values of patients and available resources.
Conclusion
Management of chronic neck and back pain can represent a clinical dilemma due to the multiplicity of pain generators that may coexist in the same individual resulting in a complex type and pattern of pain. Approach to these patients requires contributions from the members of a multidisciplinary team, implementing a standardized approach in a well-equipped healthcare facility.
... In patients who experienced the failure of other pain therapies, the use of implantable drug-delivery systems was associated with disability reduction and significant improvement of QoL and patient satisfaction with this therapy [81]. Overall, considering both the improvement of pain intensity in at least the short and medium terms, and the equivocal results in terms of functional improvement [79], further studies are required to fully support interventional pain procedures' role in LBP management [82]. ...
Acute low back pain (LBP) stands as a leading cause of activity limitation and work absenteeism, and its associated healthcare expenditures are expected to become substantial when acute LBP develops into a chronic and even refractory condition. Therefore, early intervention is crucial to prevent progression to chronic pain, for which the management is particularly challenging and the most effective pharmacological therapy is still controversial. Current guideline treatment recommendations vary and are mostly driven by expertise with opinion differing across different interventions. Thus, it is difficult to formulate evidence-based guidance when the relatively few randomized clinical trials have explored the diagnosis and management of LBP while employing different selection criteria, statistical analyses, and outcome measurements. This narrative review aims to provide a critical appraisal of current acute LBP management by discussing the unmet needs and areas of improvement from bench-to-bedside, and proposes multimodal analgesia as the way forward to attain an effective and prolonged pain relief and functional recovery in patients with acute LBP.
... Numerous pro-inflammatory and anti-inflammatory proteins have been found in serum, cerebrospinal fluid and disc biopsies from patients with lumbar radicular pain [8][9][10] . Treatment of lumbar radicular pain includes pharmacotherapy, physical therapy, minimally invasive treatment and surgery 11 . Opioid analgesics are also used for the treatment of severe pain, which are effective but can cause side effects in some patients 12 . ...
... Techniques involved in PDD are chemical nucleolysis of chymopapain that produces enzymatic cleavage of the nucleus pulposus, PDD (nucleoplasty), percutaneous laser disc decompression (PLDD), and automated percutaneous lumbar discectomy (APLD) [25,43,82]. Chymopapain is deprecated due to increased risk of fatal anaphylaxis, cartilaginous endplate injury, and bleeding. ...
... Recent years have seen a large increase in the publication of randomized controlled trials (RCTs), which have been combined into systematic reviews. Most of these systematic evaluations focus on the effectiveness of a particular technique and explain how it affects various types of LBP 14 . ...
Aim: To see the comparative effectiveness of Conventional physiotherapy with kinesio Taping and Conventional physiotherapy alone to reduce pain and increase Range of Motion (ROM) in patients with non-specific low back pain. Methodology: The study design was Randomized controlled trail. Non-probability Temporal method sampling technique was used. Sample size was 36. The data was collected from Department of Physiotherapy Mayo Hospital Lahore. Written informed contest was taken from each patients taking part in this prior to performing any examination. Patients with non-specific low back pain were divided randomly into two groups. In ‘group A’ Conventional physiotherapy with Kinesio Taping was applied while in ‘group B’ only conventional physiotherapy was applied. The patients were divided into two groups using a computer-generated list. Both groups will receive conventional therapy, which will remain same throughout the study. The conventional therapy will include back isometrics and hot pack for 15 minutes. Group A will receive conventional therapy and Kinesio Taping while group B will receive only conventional therapy. Treatment frequency will be thrice a week. The duration of treatment was be 2 weeks in both groups. Each patient's informed consent was obtained before Performa was filled out. The Roland Morris Disability Questionnaire and the Visual Analogue Scale (VAS) were both utilized for scoring. Results: Kinesio Taping with Traditional Physical Therapy technique is more effective in improving ROM and reducing disability as compared to only Traditional Physical Therapy technique. Patients in group A showed marked improvement as compared to group B. Conclusion: it was concluded that conventional physiotherapy with Kinesio Taping is more effective than Conventional physiotherapy alone for the treatment of low back pain. Conventional physiotherapy with Kinesio Taping not only decrease pain but also improves function and flexibility of spine. Key words: Non-specific low back pain, Kinesio-taping, Traditional physical therapy, RCT, Rehabilitation
