Is Interventional Therapy Superior to Medical Treatment in Chronic Low Back Pain?: Yes, in Considerable Cases

Chang, Sang-Bum

Ann Clin Neurophysiol > 2010 ;12(1) > Article

Ann Clin Neurophysiol. 2010; 12(1): 3-6.

Sang-Bum Chang

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

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.

Key words: Chronic low back pain, Interventional treatment