Injection therapy for subacute and chronic low-back pain

Abstract

Injection therapy for subacute and chronic low-back pain (Review)

Langzeiteffekte interventioneller Behandlungen von chronischen Schmerzen des Bewegungssystems

“…B. im Bereich der Wirbelsäule, sind verschiedenste Injektionsverfahren weitverbreitet [6,10]. Für die meisten interventionellen Verfahren sind nur kurzfristige Wirkungen nachweisbar oder es gibt keine positive, z. T. sogar eine negative wissenschaftliche Evidenzlage [11,12,13,14,15,16,17,18,19,20]. Psychosoziale Einflussfaktoren auf chronische Schmerzsyndrome sind wissenschaftlich gut evaluiert.…”

Epidural Steroid Injections

“…ESI may benefit people with spinal stenosis, though the success rate tends to be lower and the duration of effect shorter than for herniated disc [18]. ESIs also have been advocated as a treatment of axial LBP; however, the effect size is small and only a small percentage of people will obtain clinically meaningful benefit [19]. Overall, the evidence for short-term relief with interlaminar ESI (ILESI) ranges from weak to moderate, with conflicting evidence for long-term relief.…”

“…Less evidence is available for caudal ESI, but there exists a general consensus that it is inferior to TFESI. This may be because the higher volumes needed to reach the areas of Freynhagen et al [85] Multicenter study in Germany 7772 pts with chronic LBP painDETECT 37% of patients found to have predominantly neuropathic pain El Sissi et al [86] Prospective, multicenter, epidemiological study 1134 LANSS 55% of patients with chronic back pain were found to have neuropathic pain Beith et al [87] Cross-sectional study 343 with LBP painDETECT 59% reported likely nociceptive pain, 25% had pain with unclear mechanisms, and 16% had possible neuropathic pain Kaki et al [88] Multicenter (117) Staal et al [19] Epidemiology Insufficient evidence to support the use of injection therapy in subacute and chronic low back pain Armon et al [90] Neurology Does not impact function, decrease rate of surgery, or provide pain relief for >3 month Carragee et al [91] Orthopedic surgery Injection procedures for cervical radicular symptoms may be reasonably considered in patients with severe impairments Deyo et al [8] Internal medicine Increases in expenditures for ESI are not accompanied by improvements in patient outcomes Roberts et al [92] Physical medicine Fair evidence supporting TFESIs for treatment of radicular symptoms, good evidence for surgery sparing. TFESI superior to ILESI for radicular pain DePalma et al [48] Physical medicine Moderate evidence supporting use of ILESIs in treating lumbar radicular symptoms.…”

Predictors of facet joint syndrome after lumbar disc surgery

“…Clinical evaluation often results in the diagnosis of postoperative facet joint syndrome (pFJS) [7][8][9][10] , which is confirmed by a facet joint injection with anesthetic agents. [11][12][13][14][15][16][17][18] Data on the prevalence of a pFJS in postsurgical patients are scarce, as few studies have investigated this problem. 4,10,19,20 The prevalence of pFJS in patients after lumbar intervention is between 8% and 32%.…”