Lei Zhao1, Laxmaiah Manchikanti2, Alan David Kaye3, Alaa Abd-Elsayed4. 1. Department of Orthopedics, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, 250021, China. 2. Pain Management Centers of America, Paducah, KY, USA. 3. Departments of Anesthesiology and Pharmacology, Louisiana State University School of Medicine, 1501 Kings Highway, Shreveport, LA, 71103, USA. akaye@lsuhsc.edu. 4. Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WA, USA.
Abstract
PURPOSE OF REVIEW: Many studies have demonstrated that discogenic low back pain is the most common type of chronic low back pain (CLBP), one of the major causes of disability, and has a major socioeconomic impact. Our aim is to review present therapeutic interventions for discogenic low back pain. RECENT FINDINGS: There are a multitude of treatments used in clinical practice to treat CLBP, but there is continued debate and lack of consensus among clinicians and the policy makers as to which modality is the best approach. Based on controlled evaluations, lumbar intervertebral discs have been shown to be the source of chronic back pain without disc herniation in 26 to 39% of patients. Treatment modalities include noninvasive treatments such as drug therapy, multiple physical modalities, and multidisciplinary biopsychosocial rehabilitation; interventional modalities such as intradiscal therapies and epidural injections; and regenerative modalities with disc injections of various solutions; and, finally, surgical approaches such as fusion and artificial disc replacement, all of which are accompanied by significant discussion, limited evidence, and lack of consensus. The results of this evaluation show that the evidence for drug therapy in chronic discogenic low back pain is limited; for multidisciplinary biopsychosocial rehabilitation, it is moderate; and for multiple physical and behavioral therapies, the evidence is limited. For intradiscal therapies, it is poor; for epidural injections, it is moderate; and for regenerative therapies, evidence levels of 3 to 4. The evidence for surgical fusions and disc replacement is similar, without superiority when compared with multidisciplinary biopsychosocial rehabilitation, well-designed physical therapy, or epidural injections.
PURPOSE OF REVIEW: Many studies have demonstrated that discogenic low back pain is the most common type of chronic low back pain (CLBP), one of the major causes of disability, and has a major socioeconomic impact. Our aim is to review present therapeutic interventions for discogenic low back pain. RECENT FINDINGS: There are a multitude of treatments used in clinical practice to treat CLBP, but there is continued debate and lack of consensus among clinicians and the policy makers as to which modality is the best approach. Based on controlled evaluations, lumbar intervertebral discs have been shown to be the source of chronic back pain without disc herniation in 26 to 39% of patients. Treatment modalities include noninvasive treatments such as drug therapy, multiple physical modalities, and multidisciplinary biopsychosocial rehabilitation; interventional modalities such as intradiscal therapies and epidural injections; and regenerative modalities with disc injections of various solutions; and, finally, surgical approaches such as fusion and artificial disc replacement, all of which are accompanied by significant discussion, limited evidence, and lack of consensus. The results of this evaluation show that the evidence for drug therapy in chronic discogenic low back pain is limited; for multidisciplinary biopsychosocial rehabilitation, it is moderate; and for multiple physical and behavioral therapies, the evidence is limited. For intradiscal therapies, it is poor; for epidural injections, it is moderate; and for regenerative therapies, evidence levels of 3 to 4. The evidence for surgical fusions and disc replacement is similar, without superiority when compared with multidisciplinary biopsychosocial rehabilitation, well-designed physical therapy, or epidural injections.
Entities:
Keywords:
Degeneration; Diagnosis; Discogenic low back pain; Intervertebral disc; Treatment
Authors: Annu Navani; Laxmaiah Manchikanti; Sheri L Albers; Richard E Latchaw; Jaya Sanapati; Alan D Kaye; Sairam Atluri; Sheldon Jordan; Ashim Gupta; David Cedeno; Alejandro Vallejo; Bert Fellows; Nebojsa Nick Knezevic; Miguel Pappolla; Sudhir Diwan; Andrea M Trescot; Amol Soin; Adam M Kaye; Steve M Aydin; Aaron K Calodney; Kenneth D Candido; Sanjay Bakshi; Ramsin M Benyamin; Ricardo Vallejo; Art Watanabe; Douglas Beall; Todd P Stitik; Patrick M Foye; Erik M Helander; Joshua A Hirsch Journal: Pain Physician Date: 2019-01 Impact factor: 4.965
Authors: Steven J Kamper; Andreas T Apeldoorn; Alessandro Chiarotto; Rob J E M Smeets; Raymond W J G Ostelo; Jaime Guzman; Maurits W van Tulder Journal: Cochrane Database Syst Rev Date: 2014-09-02
Authors: Brian J C Freeman; Robert D Fraser; Christopher M J Cain; David J Hall; David C L Chapple Journal: Spine (Phila Pa 1976) Date: 2005-11-01 Impact factor: 3.468
Authors: Shirley N Tang; Benjamin A Walter; Mary K Heimann; Connor C Gantt; Safdar N Khan; Olga N Kokiko-Cochran; Candice C Askwith; Devina Purmessur Journal: Front Pain Res (Lausanne) Date: 2022-06-22
Authors: Amparo Vanaclocha-Saiz; Vicente Vanaclocha; Carlos M Atienza; Pablo Clavel; Pablo Jorda-Gomez; Carlos Barrios; Leyre Vanaclocha Journal: ACS Appl Bio Mater Date: 2021-12-14
Authors: S Tang; A Salazar-Puerta; J Richards; S Khan; J A Hoyland; D Gallego-Perez; B Walter; N Higuita-Castro; D Purmessur Journal: Eur Cell Mater Date: 2021-01-19 Impact factor: 3.942