Physical medicine and rehabilitation clinics of North America
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Radiofrequency (RF) neurotomy is an interventional procedure used to alleviate certain types of low back pain. RF energy is used to thermally coagulate the specific nerves that transmit pain signals. Recent evidence has shown that this procedure demonstrates significant efficacy in relieving low back pain in lumbar zygapophysial joints, and research is ongoing to determine if pain relief for the sacroiliac joint is also possible. This article provides an evidence-based background for performing RF neurotomy, discusses the relevant anatomy, and highlights the indications and technique for lumbar and sacral RF neurotomy.
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Phys Med Rehabil Clin N Am · Nov 2010
Review Historical ArticleThe use of spinal cord stimulation and intrathecal drug delivery in the treatment of low back-related pain.
Spinal cord stimulation (SCS) and intrathecal drug delivery (IDD) are forms of neuromodulation, meaning that they are reversible and nondestructive. SCS is generally limited to conditions such as radiculopathy and pain of CNS origin. IDD is primarily effective for nociceptive or mixed pain, and its usage is generally limited to conditions within that realm.
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Imaging is an integral part of the clinical examination of the patient with back pain; it is, however, often used excessively and without consideration of the underlying literature. The primary role of imaging is the identification of systemic disease as a cause of the back or limb pain; magnetic resonance imaging (MRI) excels at this. Systemic disease as a cause of back or limb pain is, however, rare. ⋯ The zygapophysial (facet) and sacroiliac joint are thought to be responsible for axial back pain, although with less frequency than the disc. Imaging findings of the structural changes of osteoarthritis do not correlate with pain production. Physiologic imaging, either with single-photon emission CT bone scan, heavily T2-weighted MRI sequences (short-tau inversion recovery), or gadolinium enhancement, can detect inflammation and are more predictive of an axial pain generator.
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Phys Med Rehabil Clin N Am · Nov 2010
ReviewPharmacologic treatment for low back pain: one component of pain care.
Analgesic medications are commonly used for low back pain (LBP). Evidence on the efficacy of pharmacologic therapy for LBP comes from clinical trials that have many limitations, including short-term studies and selective trial populations. Evidence currently supports the use of short-term pharmacologic treatment for LBP. However, the safety and efficacy of long-term pharmacologic therapy for LBP is uncertain and therefore best used with caution, monitoring, and as one component of a comprehensive paincare approach emphasizing rehabilitation.
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Epidural steroid injection (ESI) has been used as a treatment for low back pain for over 50 years. In the last 10 to 15 years, there has been a significant increase in the use of ESIs for the treatment of low back pain and radicular pain without clear improvements in outcomes. ⋯ There is a lack of literature, however, to support the use of ESIs for the treatment of axial low back pain. The theoretical basis for their use, technical considerations, and the literature available for different approaches of access to the epidural space as pertaining to the treatment for low back pain without radiculopathy are reviewed.