Chronic non-specific low back pain (CLBP) is one of the major health problems casting substantial amount of economicexpenses and negative impact on quality of life onto an individual as well as society. On contrary to public familiarity, theways of management of CLBP are diverse and there is yet no general consensus about which approach is better than othersor to whom the specific management should be applied. Some hold the negative point of view on the efficacy of the invasivemaneuver such as epidural injection because there is no controlled clinical trial (RCT) yielding better long term outcomeof those invasive managements over conservative ones. But the experts of interventional or surgical treatment stress the methodologicaldifficulty in performing RCT and assert that those invasive treatments can bring the prompt and complete resolutionof low back pain and restoration of function in appropriately selected cases. These seemingly opposite views on theinvasive management on CLBP are rather complimentary each other than to be contradictory.

The British guideline for early management of persistent low back pain, published in 2009, indicated that physicians shouldoffer exercise or medication, rather than radiological interventions or injections, as first choice of treatment in the patientswith chronic low back pain (CLBP). However, there had been great controversies regarding the effectiveness of interventionaltreatment of patients with CLBP.Both somatic (discogenic, instability, etc) and psychosocial factors contribute to the pathophysiology of chronic low backpain (CLBP). Although it can be difficult in many occasions, thorough interview with the patients and specific diagnosticapproaches can help us to identify which is the main etiology in individual patient. With the recent progress in medicalradiology and development of new therapeutic modalities, some subgroups of patients of CLBP caused by somatic factorsappear to be good candidates of interventional therapy.Interventional therapy can be considered in patients with CLBP caused by annulus rupture, facet joint degeneration, discdegeneration, and vertebral column instability. Among other subgroups of CLBP, carefully selected patients with disc degenerationshow the most favorable result by interventional therapy. In this regard, discogenic pain, either as a form of CLBPor acute discogenic radiculopathy, seems to be a good indication of interventional therapy. Because many spine specialistsgenerally consider those with radiculopathy are easier to be treated, patients with CLBP tend to be subjects of conventionalconservative therapy. For these reasons, clinicians should make their best effort to identify every possible somatic cause inpatients with CLBP before regarding them as hypochondriacs.In this review, some of the recent evidence on the role of interventional treatment in patients with CLBP will be discussed,and some of our cases who showed favorable results by interventional therapy will be presented.

Chronic low back pain (CLBP) is a distinct disease entity in that its clinical course and response to the treatment arequite different from acute low back pain (ALBP). CLBP is also closely related with systemic or preexisting psychosocialfactors rather than focal or localized factors. Since there has been little consensus in practice regarding the proper managementof CLBP, clinicians tend to approach and manage patients with CLBP in an empirical manner rather than an evidence-based one. In this article, I will review the difficulties of therapeutic choice in CLBP and provide superior aspectsof medical treatment over invasive interventional treatments.

Low back pain is a common clinical condition with heterogeneous causes and challenges to manage. High prevalence andnumerous assessments result in an enormous socioeconomic burden. Clinician must conduct efficient and stepwise evaluationprocess to rule out serious spinal pathology, neurologic involvement, and identify risk factors for chronicity. The processcan be achieved through the focused history taking and physical examination. Certain factors related to serious spinalpathology include age (>50 years), trauma, unexplained fever, recent urinary or skin infection, unrelenting night or rest pain,unexplained weight loss, osteoporosis, immunosuppression, steroid use, and widespread neurological symptoms. In non-specificlow back pain, diagnostic imaging and laboratory studies are often unnecessary and can disturb an appropriate management.For the management of acute low back pain, patient education and medication such as acetaminophen, non-steroidalanti-inflammatory drugs, and muscle relaxants are recommended. For chronic low back pain, behavior therapy, back exercise,and spinal manipulation are beneficial. The evidence based approach could improve success rate of management, result inprevention of acute low back pain from being chronic intractable pain.