Articles: low-back-pain.
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Caudal epidural administration of corticosteroids is one of the commonly used interventions in managing chronic low back pain. Reports of the effectiveness of all types of epidural steroids have varied from 18% to 90%. Sicard, a radiologist, was the first to describe injection of dilute solutions of cocaine through the sacral hiatus into the epidural space in 1901, to treat patients suffering from severe, intractable sciatic pain or lumbago. ⋯ The clinical effectiveness evaluations fill the literature with various types of reports including randomized clinical trials, prospective trials, retrospective studies, case reports, and meta-analyses. Evidence from all types of evaluations with regards to the clinical and cost-effectiveness of caudal epidural injections is encouraging. This review discusses various aspects of the role of caudal epidural injections in the management of chronic low back pain, including pathophysiology of low back pain, indications, clinical effectiveness and complications.
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Curr Pain Headache Rep · Apr 2002
ReviewChronic lumbar spine and radicular pain: pathophysiology and treatment.
The lumbar spine forms the foundation and infrastructure of an organic skyscraper equipped with the physiologic capacity to act as a crane for lifting and a crankshaft for walking. Subjected to aging like other "human machinery," the lumbar spine adapts to the wear and tear of gravity and biomechanical loading through structural and neurochemical changes. ⋯ Some compensatory reactions are constructive, but others cause more interference with the organism's capacity to cope. A conceptional understanding of the multifaceted structural, biomechanical, biochemical, medical, and psychosocial influences that compose this mix elucidates the complexity of applying effective treatments.
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Spinal cord stimulation is the most common mode of neuromodulation used in managing chronic low back pain. It is minimally invasive and reversible as opposed to nerve ablation. The basic scientific background of the initial spinal cord stimulation trials was based on the gate control theory of Melzack and Wall. ⋯ There is substantial scientific evidence on the efficacy of spinal cord stimulation for treatment of low back and lower extremity pain of neuropathic nature. Clinical studies revealed a success rate of from 50% to 70% with spinal cord stimulation, with decreased pain intensity scores, functional improvement and decreased medication usage. This review discusses multiple aspects of spinal cord stimulation, including pathophysiology and mechanism of action, rationale, indications, technique, clinical effectiveness, and controversial aspects.
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Many commissions and groups throughout the world have proposed clinical guidelines on the management of low back pain, spinal pain, and chronic pain. Practice guidelines are systematically developed statements to assist the practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. The American Society of Interventional Pain Physicians developed practice guidelines for interventional techniques which are professional practice recommendations for practices for prevention, diagnosis and treatment of acute and chronic painful disorders, and in some cases, disability management. ⋯ The results consistently showed decrease in number of visits from 1999 to 2000 and 2001 with 5.5 +/- 0.18, 5.1 +/- 0.17, and 4.3 +/- 0.15 respectively. The average expenditure also decreased from per visit of $872 in 1999 to $891 in 2000, to $810 to 2001. further, the average expenditure per year also decreased as expected due to decrease in frequency of visits, as well as the average expenditure per visit from $4751 +/- $231 in 1999 to $4505 +/- $214 in 2000 and to $3514 +/- $193 in 2001 even without consideration of inflation. Thus, it is concluded that guidelines describing the interventional techniques in the management of chronic pain are effective in reducing the cost and frequency of visits with improvement or at least maintenance of similar outcomes, physician decision making abilities, and patient preferences.
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Multiple studies have documented a strong association between chronic low back pain and psychopathology including personality disorders, depressive disorders, anxiety, and somatoform disorders along with non-specific issues such as emotion, anger and drug dependency. However, depression, anxiety and somatization appear to be crucial. There are no controlled trials in interventional pain management settings. ⋯ All the participants were tested utilizing Pain Patient Profile (P3). Significant differences were found among various clinical syndromes with generalized anxiety disorder, somatoform disorder, and depression, with 0% vs 20%, 0% vs 20%, and 5% vs 30% in Group I and Group II consecutively. This evaluation showed that clinical syndromes were seen in a greater proportion of patients with chronic low back pain emphasizing the importance of evaluation of the patients for generalized anxiety disorder, somatoform disorder, and for depression.