• Norman J Marcus, Allyson Augusta Shrikhande, Bill McCarberg, and Edward Gracely.
• Department of Anesthesiology, NYU Langone Medical Center, Norman Marcus Pain Institute, New York, New York 10016, USA. njm@nmpi.com
• Pain Med. 2013 Aug 1;14(8):1212-21.

ObjectiveTo assess the effectiveness of a muscle protocol to treat patients diagnosed with neuraxial low back pain (LBP) before and after invasive treatments.DesignPatients with chronic (>6 months) LBP-postinvasive treatment and pre-spine surgery-were assessed and treated. An electrical device rather than palpation was used to determine muscle(s) as possible sources of pain. Patients testing positive for muscle pain were treated with a comprehensive protocol and were followed for >3 months to determine the effect of treatment on pain severity and interference in function.ResultsStudy 1: In 56 (postinvasive treatment) patients who had failed back surgery, epidural steroid injections, facet blocks, and/or trigger point injections, mean Brief Pain Inventory (BPI) pain severity dropped from 5.54 at baseline to 3.96 (P < 0.001) at a median follow-up of 77 weeks; mean BPI interference dropped from 6.09 to 3.4 (P < 0.001). Fifty-two percent of respondents reported over 50% relief. Study 2: Three of seven patients originally scheduled for spine surgery completed a substantial part of the muscle protocol, canceled their surgeries, and obtained significant relief at the 16-19 month follow-up point.ConclusionIn patients thought to have neuraxial pain, identification and treatment of painful muscles had statistically significant long-lasting and clinically meaningful reductions in pain and improvement in function. Muscle and tendon attachments may be an important and treatable source of pain in patients diagnosed with pre and postsurgical neuraxial pain.Wiley Periodicals, Inc.

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