Benefits of the Various Pain Procedures as Therapeutic Option in Low Back Pain

OBJECTIVE: The authors retrospectively evaluate the benefits of the various pain procedures for the treatment of low back pain unresponsive to conservative management. METHODS: Over a period of 2 years from May 2002 and June 2004, the authors had performed various pain procedures on 106 patients with low back pain. Epidural block, facet joint block, sacroiliac joint block, and myofascial block were included among various pain procedures. The pain improvement, period of analgesic use, and degree of satisfaction were evaluated 1 day, 4 weeks, and 6 months after injections. The outcome of pain procedures was analyzed by using a modified Macnab criteria. RESULTS: Sixty-four patients had a single procedure with no combination and 42 patients (39.6%) received the combination of the various pain procedure. Regardless of the single or combination cases of procedure, combination of appropriate spinal level on each procedure was conducted in 104 (98.1%). Mean follow up period was 12.2 months. Eighty-two patients (77.4%) experienced significant pain relief and overall analgesic medication was reduced in 91 patients (85.8%) at 6 months after procedure. Unfavorable results were demonstrated in 10 patients. Permanent procedural complications did not occur. CONCLUSION: The various pain procedures are the possible therapeutic option for low back pain unresponsive to conservative management including medication or physical therapy.

The Effect of Combined Nerve Block for Low Back Pain

OBJECTIVE: At present, epidural steroid injection is one of the most frequently used method in the treatment for low back pain. But this method is nonspecific and results in a widespread of injected agent around the target point. So, we introduce combined nerve block and had good results. METHODS: The authors evaluated the effects of combined nerve block in 153 patients with low back pain, retrospectively. They had spinal stenosis, facet syndrome, herniated lumbar disc and failed back surgery syndrome. We operated combined nerve block to patients respectively, that is caudal block, facet block and iliolumbar & sacroiliac joint block. We used Depomedrol(R) 80mg in 2ml and 2% Emcaine(R) 400mg in 20ml as injection agents, Visual analog scale(VAS) for assessment of the effect was used. RESULTS: Six months after nerve block, the outcome of treatment for back pain was cured(a decrease in VAS score from 4 and over to 3 and under) in 35.3%, improved(a decrease in VAS score but 4 and over) in 32.7% and unchanged(no change in VAS score) in 32.0%. Overall rate of improvement was 68.0%. CONCLUSION: We think that combined nerve block is more specific and effective in patients with low back pain. Therefore, this technique could be alternative method to epidural steroid injection.