• William C Watters, Daniel K Resnick, Jason C Eck, Zoher Ghogawala, Praveen V Mummaneni, Andrew T Dailey, Tanvir F Choudhri, Alok Sharan, Michael W Groff, Jeffrey C Wang, Sanjay S Dhall, and Michael G Kaiser.
• Bone and Joint Clinic of Houston, Houston, Texas;
• J Neurosurg Spine. 2014 Jul 1;21(1):79-90.

AbstractThe medical literature continues to fail to support the use of lumbar epidural injections for long-term relief of chronic back pain without radiculopathy. There is limited support for the use of lumbar epidural injections for shortterm relief in selected patients with chronic back pain. Lumbar intraarticular facet injections are not recommended for the treatment of chronic lower-back pain. The literature does suggest the use of lumbar medial nerve blocks for short-term relief of facet-mediated chronic lower-back pain without radiculopathy. Lumbar medial nerve ablation is suggested for 3-6 months of relief for chronic lower-back pain without radiculopathy. Diagnostic medial nerve blocks by the double-injection technique with an 80% improvement threshold are an option to predict a favorable response to medial nerve ablation for facet-mediated chronic lower-back pain without radiculopathy, but there is no evidence to support the use of diagnostic medial nerve blocks to predict the outcomes in these same patients with lumbar fusion. There is insufficient evidence to support or refute the use of trigger point injections for chronic lowerback pain without radiculopathy.

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