Neuromodulation : journal of the International Neuromodulation Society
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The use of spinal cord stimulation (SCS) is well established in the treatment of neuropathic pain. This procedure has been approved in the United States for neuropathic pain of the trunk and limbs from various conditions. International use is variable based on governmental policy. Most studies showing efficacy have focused on pain primarily in the limbs for such conditions as complex regional pain syndrome (CRPS), sciatica, radiculitis, ischemic limb pain, and peripheral neuropathy. Data on success in neuropathic pain of the trunk and particularly of the axial back are limited. New understanding about the targets of neuromodulation and their treatment with novel neurostimulation approaches has led to a new dawn of enthusiasm for spinal cord stimulation for axial low back pain. ⋯ Improved technology and a better understanding of the goals of stimulation have led to a new ability to stimulate the axial low back and increase the effectiveness of these therapies to reduce pain. New paddle lead constructs, percutaneous paddle lead introduction, and other new technologies have led to an increased number of potential candidates for spinal cord stimulation. Optimizing the application of neurostimulation for chronic axial back pain will depend upon answering questions relating to patient selection, implantation technique, and stimulation parameters.
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To review spine surgery management strategies for patients with chronic low back pain (CLBP) that has failed to respond to all nonsurgical treatment options. ⋯ Despite the number of spine surgeries that have been performed for CLBP, the surgical outcome still remains questionable. Until a precise identification of the cause of CLBP in any given patient can be precisely determined, surgical solutions will continue to be less than optimal.
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The goal of this article is to provide a thorough literature review of available noninvasive and alternative treatment options for chronic low back pain. In particular, the efficacy of each therapy is evaluated and pertinent outcomes are described. ⋯ There are a wide variety of noninvasive and alternative therapies for the treatment of chronic low back pain. Those with the strongest evidence in the literature for good efficacy and outcomes include exercise therapy with supervised physical therapy, multidisciplinary biopsychosocial rehabilitation, and acupuncture. Therapies with fair evidence or moderately supported by literature include yoga, back schools, thermal modalities, acupressure, and cognitive-behavioral therapy. Those therapies with poor evidence or little to no literature support include manipulation, transcutaneous electrical nerve stimulation, low-level laser therapy, reflexology, biofeedback, progressive relaxation, hypnosis, and aromatherapy. Providers delivering care for patients with chronic low back pain must carefully evaluate these available treatment options related to their efficacy or lack thereof as well as relevant outcomes.
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Chronic low back pain (CLBP) is common and contributes to significant disability and healthcare costs. The mechanism and etiology of CLBP are frequently unclear, and treatment choices vary. ⋯ Personalized treatment plans should be informed by response to therapies previously tried, the severity and persistence of symptoms, and the availability of specialist expertise.
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The issue of low back pain (LBP) is as common as it is perplexing. LBP is thought to be a chronic issue in approximately 10% of the U.S. population. This condition has wide-reaching social and economical reverberations. Despite the availability of modern diagnostic tools, the cause of the pain generator is often unidentifiable. The authors were asked to create an overview of the etiology of LBP for physicians who implant neurostimulation devices for the treatment of chronic pain patients. Some prevalence data, based on the current available literature, have been provided for the more common structural conditions causing LBP. However, a comprehensive review of prevalence of various conditions and their respective manifestations as LBP is beyond the scope of this article. ⋯ LBP is an extremely common condition associated, as a symptom, with various disease processes, regardless of their relationship with the lumbar spine or its innervation. This article underscores the broad nature of LBP as a symptom of many diagnoses. The primary conclusion reached by the authors is the most important recommendation by all mentors in medicine, which is to obtain a comprehensive history and perform a complete physical examination on each patient. Despite the fact that there is an emerging school of thought questioning the validity of the physical examination, this tool continues to be the current standard of care and used by a majority of clinicians around the world. The physician must analyze the information obtained from his/her history, physical examination, and diagnostic tools with the recognition of the broad nature of the differential diagnoses of LBP in order to be able to best treat the patient.