Management of Low Back Pain - Call for an Integrated Interventional Approach

Abstract

Introduction: Using advanced imaging, neurophysiologic and precision diagnostic techniques spinal pain can be diagnosed in only 50 to 80% of the patients. 20 to 50% remain incorrectly diagnosed. Furthermore axial and periaxial pattern of pain from ligaments, muscles, intervertebral discs and facet joints overlap significantly. Therefore patients continue to suffer because of diagnostic dilemma and also pose a therapeutic challenge. Rarely does low back pain involve only a single pain generator, therefore it is unlikely that a single treatment, such as surgery will result in the best outcome for the majority of the causes of low back pain.Materials and method: All cases of Low back Pain reporting to tertiary care service hospital from 2012 to 2016 were evaluated. Cases which responded to conservative management were excluded.Observation: A total of 374 cases were offered pain intervention procedure. Of these 45 (12%) required a second interventional procedure as the pain relief was poor. All cases were followed up for 6 months and pain relief was recorded as Good, satisfactory or poor as told by the patient. We found that 78% reported good relief, 18% reported satisfactory relief while 4% reported poor relief from pain.Conclusion: Scientific evaluation of interventional pain treatments is difficult due to lack of any objective test for pain. Also we cannot have true controls. A single interventional procedure may not suffice in all cases. The Surgeon needs to adopt other modalities to provide pain relief to the ailing patient.