Interventional diagnosis and treatment methods of discogenic and musculoskeletal low back pain
https://doi.org/10.14412/2074-2711-2024-2-101-107
Abstract
Low back pain (lumbar pain) is one of the most common causes of disability in the population. In cases where conservative treatment of discogenic or musculoskeletal low back pain does not have a positive effect, interventional methods of diagnosis and treatment are used, which are developing actively on the background of rapid technological progress. Being on the border of interdisciplinary interaction, interventional methods can significantly shorten the duration of conservative therapy and, in many cases, avoid surgical decompressive interventions, which are associated with a considerable risk of complications. The methods, efficacy and safety of epidural administration of glucocorticoids for discogenic radiculopathy and lumbar stenosis as well as the methods of radiofrequency denervation for musculoskeletal pain due to the facet joints and the sacroiliac joint involvement are discussed. The possibilities of drug therapy for musculoskeletal pain of the lumbar spine, and combination of non-steroidal anti-inflammatory drugs and a vitamin B complex, are discussed.
About the Authors
D. A. Ptashnikov
Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden;
North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russia
Russian Federation
Competing Interests:
Russian Federation
Department of Traumatology, Orthopedics and Military Surgery
8, Akademika Baykova St., St. Petersburg 195427;
47, Piskarevskiy Prosp., St. Petersburg 195067
Competing Interests:
This article has been supported by Woerwag Pharma. The conflict of interest has not affected the results of the investigation. The authors are solely responsible for submitting the final version of the manuscript for publication. All the authors have participated in developing the concept of the article and in writing the manuscript. The final version of the manuscript has been approved by all the authors.
I. V. Volkov
Clinical Hospital RZD-Medicine
Russian Federation
Competing Interests:
Russian Federation
27, Mechnikov Prosp., St. Petersburg 195271
Competing Interests:
This article has been supported by Woerwag Pharma. The conflict of interest has not affected the results of the investigation. The authors are solely responsible for submitting the final version of the manuscript for publication. All the authors have participated in developing the concept of the article and in writing the manuscript. The final version of the manuscript has been approved by all the authors.
E. N. Lim
Surgemed Clinic
Uzbekistan
Competing Interests:
Uzbekistan
96A, Al-Horezmi St., Urgench 220100
Competing Interests:
This article has been supported by Woerwag Pharma. The conflict of interest has not affected the results of the investigation. The authors are solely responsible for submitting the final version of the manuscript for publication. All the authors have participated in developing the concept of the article and in writing the manuscript. The final version of the manuscript has been approved by all the authors.
S. G. Normatov
Surgemed Clinic
Uzbekistan
Competing Interests:
Uzbekistan
96A, Al-Horezmi St., Urgench 220100
Competing Interests:
This article has been supported by Woerwag Pharma. The conflict of interest has not affected the results of the investigation. The authors are solely responsible for submitting the final version of the manuscript for publication. All the authors have participated in developing the concept of the article and in writing the manuscript. The final version of the manuscript has been approved by all the authors.
Su Lee Chan
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
Russian Federation
Competing Interests:
Russian Federation
Department of Nervous Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine
11, Rossolimo St., Build. 1, Moscow 119021
Competing Interests:
This article has been supported by Woerwag Pharma. The conflict of interest has not affected the results of the investigation. The authors are solely responsible for submitting the final version of the manuscript for publication. All the authors have participated in developing the concept of the article and in writing the manuscript. The final version of the manuscript has been approved by all the authors.
References
1. Hoy D, Bain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012 Jun;64(6):2028-37. doi: 10.1002/art.34347. Epub 2012 Jan 9.
2. Evans L, O'Donohoe T, Morokoff A, Drummond K. The role of spinal surgery in the treatment of low back pain. Med J Aust. 2023 Jan 16;218(1):40-5. doi: 10.5694/mja2.51788. Epub 2022 Dec 11.
3. Guscha AO, Konovalov NA, Grin AA. Khirurgiya degenerativnykh porazheniy pozvonochnika. Natsional'noye rukovodstvo [Surgery of degenerative lesions of the spine. National Guide]. Moscow: GEOTAR-Media; 2019. 480 p. (In Russ.).
4. Bailey CS, Rasoulinejad P, Taylor D, et al. Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months. N Engl J Med. 2020 Mar 19;382(12):1093-102. doi: 10.1056/NEJMoa1912658
5. Liu C, Ferreira GE, Abdel Shaheed C, et al. Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials. BMJ. 2023 Apr 19;381:e070730. doi: 10.1136/bmj2022-070730
6. Zakirov AA, Dreval' ON, Chagava DA, et al. Treatment of spondyloarthrosis and lumbar discopathy by combined minimally invasive techniques. Voprosy neirokhirurgii im. N.N. Burdenko. 2012;2(7):17-22 (In Russ.).
7. Giurazza F, Guarnieri G, Murphy KJ, Muto M. Intradiscal O2O3: Rationale, Injection Technique, Short- and Long-term Outcomes for the Treatment of Low Back Pain Due to Disc Herniation. Can Assoc Radiol J. 2017 May;68(2):171-7. doi: 10.1016/j.carj.2016.12.007
8. Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013 Jan;13(1):99-116. doi: 10.1586/ern.12.148
9. Vleeming A, Schuenke MD, Masi AT, et al. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012 Dec;221(6):537-67. doi: 10.1111/j.1469-7580.2012.01564.x. Epub 2012 Sep 19.
10. Sayed D, Grider J, Strand N, et al. The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain. J Pain Res. 2022 Dec 6;15:3729-832. doi: 10.2147/JPR.S386879. Erratum in: J Pain Res. 2022 Dec 24;15:4075-6.
11. Wylde V, Dennis J, Beswick AD, et al. Systematic review of management of chronic pain after surgery. Br J Surg. 2017 Sep;104(10):1293-306. doi: 10.1002/bjs.10601. Epub 2017 Jul 6.
12. Helm Ii S, Benyamin RM, Chopra P, et al. Percutaneous adhesiolysis in the management of chronic low back pain in post lumbar surgery syndrome and spinal stenosis: a systematic review. Pain Physician. 2012 JulAug;15(4):E435-62.
13. Krut'ko AV, Kudratov AN, Evsyukov AV. Disc puncture for reflex pain syndrome of cervical osteochondrosis using coblation and chemical denervation of the intervertebral disc. Travmatologiya i ortopediya Rossii. 2011;2(60):76-81 (In Russ
14. Mikhailov DA, Usikov VD, Ptashnikov DA. Results of the treatment of degenerative dystrophic spine lumbar desease using mechanical decompressor. Travmatologiya i ortopediya Rossii. 2010;3(57):35-40 (In Russ.).
15. Shchedrenok VV, Sebelev KI, Ivanenko AV, Moguchaya OV. Outcomes of puncture methods for treatment of spinal osteochondrosis. Khirurgiya pozvonochnika. 2010;(1):46-8 (In Russ.).
16. Lu Y, Guzman JZ, Purmessur D, et al. Nonoperative management of discogenic back pain: a systematic review. Spine (Phila Pa 1976). 2014 Jul 15;39(16):1314-24. doi: 10.1097/BRS.0000000000000401
17. Manchikanti L, Singh V, Cash KA, et al. Fluoroscopic caudal epidural injections in managing post lumbar surgery syndrome: two-year results of a randomized, double-blind, active-control trial. Int J Med Sci. 2012;9(7):582-91. doi: 10.7150/ijms.4672. Epub 2012 Sep 8.
18. Helm Ii S, Simopoulos TT, Stojanovic M, et al. Effectiveness of Thermal Annular Procedures in Treating Discogenic Low Back Pain. Pain Physician. 2017 Sep;20(6):447-70.
19. Patel VB, Wasserman R, Imani F. Interventional Therapies for Chronic Low Back Pain: A Focused Review (Efficacy and Outcomes). Anesth Pain Med. 2015 Aug 22;5(4):e29716. doi: 10.5812/aapm.29716
20. Mu XP, Wei XH, Chen SM, et al. Intradiscal steroid injection for the treatment of chronic non-specific low back pain in patients with Modic type 1 change. Eur Rev Med Pharmacol Sci. 2023 Apr;27(8):3372-82. doi: 10.26355/eurrev_202304_32108
21. Greher M, Scharbert G, Kamolz LP, et al. Ultrasound-guided lumbar facet nerve block: a sonoanatomic study of a new methodologic approach. Anesthesiology. 2004 May;100(5):1242-8. doi: 10.1097/00000542-200405000-00028
22. Hurdle MF. Ultrasound-Guided Spinal Procedures for Pain: A Review. Phys Med Rehabil Clin N Am. 2016 Aug;27(3):673-86. doi: 10.1016/j.pmr.2016.04.011
23. Shim JK, Moon JC, Yoon KB, et al. Ultrasound-guided lumbar medial-branch block: a clinical study with fluoroscopy control. Reg Anesth Pain Med. 2006 Sep-Oct;31(5):451-4. doi: 10.1016/j.rapm.2006.06.246
24. Simopoulos TT, Manchikanti L, Singh V, et al. A systematic evaluation of prevalence and diagnostic accuracy of sacroiliac joint interventions. Pain Physician. 2012 MayJun;15(3):E305-44.
25. Evzikov GYu, Egorov OE, Rozen AI. Radio-frequency denervation in the treatment of patient with sacroiliac joint pain syndrome. Neirokhirurgiya. 2015;(2):80-5 (In Russ.).
26. Thomson S. Failed back surgery syndrome – definition, epidemiology and demographics. Br J Pain. 2013 Feb;7(1):56-9. doi: 10.1177/2049463713479096
27. Genov PG, Smirnova OV, Timerbaev VKh. Successful use of pulsed radiofrequency ablation of the spinal nerve ganglia in the treatment of a patient with chronic neuropathic pain in the stump of an amputated limb. Regionarnaya anesteziya i lecheniye ostroy boli. 2016;10(1):60-4. doi: 10.18821/1993-6508-2016-10-1-60-64 (In Russ.).
28. Zabolotsky DV, Portnyagin IV. The use of pulsed radiofrequency ablation in the treatment of severe chronic pain syndrome after shoulder arthroplasty (clinical case). Travmatologiya i ortopediya Rossii. 2015;4(78):126-30 (In Russ.).
29. Cahana A, Van Zundert J, Macrea L, et al. Pulsed radiofrequency: current clinical and biological literature available. Pain Med. 2006 Sep-Oct;7(5):411-23. doi: 10.1111/j.1526-4637.2006.00148
30. Chua NH, Vissers KC, Sluijter ME. Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications-a review. Acta Neurochir (Wien). 2011 Apr;153(4):763-71. doi: 10.1007/s00701-010-0881-5. Epub 2010 Nov 30.
31. Abejon D, Garcia-del-Valle S, Fuentes ML, et al. Pulsed radiofrequency in lumbar radicular pain: clinical effects in various etiological groups. Pain Pract. 2007 Mar;7(1):21-6. doi: 10.1111/j.1533-2500.2007.00105.x
32. Hussain AM, Afshan G. Use of pulsed radiofrequency in failed back surgery syndrome. J Coll Physicians Surg Pak. 2007 Jun;17(6):353-5.
33. Koh W, Choi SS, Karm MH, et al. Treatment of chronic lumbosacral radicular pain using adjuvant pulsed radiofrequency: a randomized controlled study. Pain Med. 2015 Mar;16(3):432-41. doi: 10.1111/pme.12624. Epub 2014 Dec 19. Erratum in: Pain Med. 2015 Oct;16(10):2048.
34. Egorov OE, Evzikov GYu. Treatment of a patient with radiculopathic pain syndrome using pulsed radiofrequency neurotomy of the posterior ganglion of the spinal nerve root. Clinical observation and literature review. Nevrologicheskiy zhurnal. 2015;20(1):28-33 (In Russ.).
35. Fu QG, Carstens E, Stelzer B, Zimmermann M. B vitamins suppress spinal dorsal horn nociceptive neurons in the cat. Neurosci Lett. 1988 Dec 19;95(1-3):192-7. doi: 10.1016/0304-3940(88)90655-6
36. Jurna I, Carlsson KH, Kömen W, Bonke D. Acute effects of vitamin B6 and fixed combinations of vitamin B1, B6 and B12 on nociceptive activity evoked in the rat thalamus: dose-response relationship and combinations with morphine and paracetamol. Klin Wochenschr. 1990 Jan 19;68(2):129-35. doi: 10.1007/BF01646861
37. Franca DS, Souza AL, Almeida KR, et al. B vitamins induce an antinociceptive effect in the acetic acid and formaldehyde models of nociception in mice. Eur J Pharmacol. 2001 Jun 15;421(3):157-64. doi: 10.1016/s0014-2999(01)01038-x
38. Mibielli MA, Geller M, Cohen JC, et al. Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: the DOLOR study. Curr Med Res Opin. 2009 Nov;25(11):2589-99. doi: 10.3111/13696990903246911
39. Calderon-Ospina CA, Nava-Mesa MO, Arbelaez Ariza CE. Effect of Combined Diclofenac and B Vitamins (Thiamine, Pyridoxine, and Cyanocobalamin) for Low Back Pain Management: Systematic Review and Meta-analysis. Pain Med. 2020 Apr 1;21(4):766-81. doi: 10.1093/pm/pnz216
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For citations:
Ptashnikov DA, Volkov IV, Lim EN, Normatov SG, Chan SL. Interventional diagnosis and treatment methods of discogenic and musculoskeletal low back pain. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(2):101-107. (In Russ.) https://doi.org/10.14412/2074-2711-2024-2-101-107
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