Is Interventional Therapy Superior to Medical Treatment in Chronic Low Back Pain?: No

만성요통의 치료에서 중재적인 치료가 보존적 치료보다 우세한가?: 부정적인 입장에서

  • Bae, Jong-Seok (Department of Neurology, Inje University College of Medicine)
  • 배종석 (인제대학교 의과대학 신경과학교실)
  • Received : 2010.06.08
  • Accepted : 2010.06.10
  • Published : 2010.06.30

Abstract

Chronic low back pain (CLBP) is a distinct disease entity in that its clinical course and response to the treatment are quite different from acute low back pain (ALBP). CLBP is also closely related with systemic or preexisting psychosocial factors rather than focal or localized factors. Since there has been little consensus in practice regarding the proper management of 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 aspects of medical treatment over invasive interventional treatments.

Keywords

References

  1. Andersson GB. Epidemiological features of chronic low-back pain. Lancet 1999;354:581-585. https://doi.org/10.1016/S0140-6736(99)01312-4
  2. Pengel LH, Herbert RD, Maher CG, Refshauge KM. Acute low back pain: systematic review of its prognosis. BMJ 2003; 327:323. https://doi.org/10.1136/bmj.327.7410.323
  3. Carragee EJ. Clinical practice. Persistent low back pain. N Engl J Med 2005;352:1891-1898. https://doi.org/10.1056/NEJMcp042054
  4. Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, et al. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine (Phila Pa 1976) 2009;34:1066-1077. https://doi.org/10.1097/BRS.0b013e3181a1390d
  5. Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001; 344:363-370. https://doi.org/10.1056/NEJM200102013440508
  6. Cassidy JD, Carroll LJ, Cote P. The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976) 1998; 23:1860-1866. https://doi.org/10.1097/00007632-199809010-00012
  7. Carey TS, Freburger JK, Holmes GM, Castel L, Darter J, Agans R, et al. A long way to go: practice patterns and evidence in chronic low back pain care. Spine (Phila Pa 1976) 2009;34:718-724. https://doi.org/10.1097/BRS.0b013e31819792b0
  8. Savigny P, Watson P, Underwood M, Guideline Development Group. Early management of persistent non-specific low back pain: summary of NICE guidance. BMJ 2009;338:b1805. https://doi.org/10.1136/bmj.b1805
  9. Boos N, Semmer N, Elfering A, Schade V, Gal I, Zanetti M, et al. Natural history of individuals with asymptomatic disc abnormalities in magnetic resonance imaging: predictors of low back pain-related medical consultation and work incapacity. Spine (Phila Pa 1976) 2000;25:1484-1492. https://doi.org/10.1097/00007632-200006150-00006
  10. Verbunt JA, Seelen HA, Vlaeyen JW, van de Heijden GJ, Heuts PH, Pons K, et al. Disuse and deconditioning in chronic low back pain: concepts and hypotheses on contributing mechanisms. Eur J Pain 2003;7:9-21. https://doi.org/10.1016/S1090-3801(02)00071-X
  11. O'Sullivan P. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Man Ther 2005;10:242-255. https://doi.org/10.1016/j.math.2005.07.001
  12. Wand BM, O'Connell NE. Chronic non-specific low back pain-sub-groups or a single mechanism? BMC Musculoskelet Disord 2008;9:11. https://doi.org/10.1186/1471-2474-9-11
  13. Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007;147: 478-491. https://doi.org/10.7326/0003-4819-147-7-200710020-00006
  14. Martell BA, O'Connor PG, Kerns RD, Becker WC, Morales KH, Kosten TR, et al. Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann Intern Med 2007;146:116-127. https://doi.org/10.7326/0003-4819-146-2-200701160-00006
  15. Basmajian JV. Cyclobenzaprine hydrochloride effect on skeletal muscle spasm in the lumbar region and neck: two double- blind controlled clinical and laboratory studies. Arch Phys Med Rehabil 1978;59:58-63.
  16. Salerno SM, Browning R, Jackson JL. The effect of antidepressant treatment on chronic back pain: a meta-analysis. Arch Intern Med 2002;162:19-24. https://doi.org/10.1001/archinte.162.1.19
  17. Hayden JA, van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med 2005;142:776-785. https://doi.org/10.7326/0003-4819-142-9-200505030-00014
  18. Kalauokalani D, Cherkin DC, Sherman KJ, Koepsell TD, Deyo RA. Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Spine (Phila Pa 1976) 2001;26:1418-1424. https://doi.org/10.1097/00007632-200107010-00005
  19. Williams K, Abildso C, Steinberg L, Doyle E, Epstein B, Smith D, et al. Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain. Spine (Phila Pa 1976) 2009;34:2066-2076. https://doi.org/10.1097/BRS.0b013e3181b315cc
  20. Clarke J, van Tulder M, Blomberg S, de Vet H, van der Heijden G, Bronfort G. Traction for low back pain with or without sciatica: an updated systematic review within the framework of the Cochrane collaboration. Spine (Phila Pa 1976) 2006;31: 1591-1599. https://doi.org/10.1097/01.brs.0000222043.09835.72
  21. Deyo RA, Walsh NE, Martin DC, Schoenfeld LS, Ramamurthy S. A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain. N Engl J Med 1990;322:1627-1634. https://doi.org/10.1056/NEJM199006073222303
  22. Carette S, Marcoux S, Truchon R, Grondin C, Gagnon J, Allard Y, et al. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. N Engl J Med 1991;325:1002-1007. https://doi.org/10.1056/NEJM199110033251405
  23. Khot A, Bowditch M, Powell J, Sharp D. The use of intradiscal steroid therapy for lumbar spinal discogenic pain: a randomized controlled trial. Spine (Phila Pa 1976) 2004;29:833-836. https://doi.org/10.1097/00007632-200404150-00002
  24. Nelemans PJ, deBie RA, deVet HC, Sturmans F. Injection therapy for subacute and chronic benign low back pain. Spine (Phila Pa 1976) 2001;26:501-515. https://doi.org/10.1097/00007632-200103010-00014
  25. Armon C, Argoff CE, Samuels J, Backonja MM. Assessment: use of epidural steroid injections to treat radicular lumbosacral pain: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2007;68:723-729. https://doi.org/10.1212/01.wnl.0000256734.34238.e7