Advancements in Interventional Pain Management of the Low Back: A Comprehensive Overview

Written by Madison Propp, OMS III

Introduction:

Low back pain (LBP) is a prevalent health issue affecting millions worldwide, leading to disability, decreased quality of life, and significant healthcare costs. While many cases of LBP resolve spontaneously or with conservative management, a substantial number of individuals experience persistent or recurrent pain that necessitates more targeted interventions. Interventional pain management (IPM) techniques have emerged as valuable tools in the multidisciplinary approach to treating chronic low back pain. In this post, we’ll explore the various interventional approaches to managing low back pain, their effectiveness, and recent advancements in the field.

Understanding the Complexity of Low Back Pain:

Low back pain is a multifaceted condition with various underlying causes, including degenerative changes, disc herniation, spinal stenosis, facet joint arthritis, sacroiliac joint dysfunction, and muscular imbalances. Therefore, a thorough assessment by a qualified health professional is essential to identify specific pain generators and tailor treatment according to each patient’s needs. Interventional pain management techniques target these pain generators directly, providing relief and improving function in patients who have failed conservative therapies.

Common Interventional Techniques:

Epidural Steroid Injections (ESIs): ESIs involve the injection of corticosteroids into the epidural space surrounding the spinal cord and nerve roots. These injections aim to reduce inflammation and alleviate pain associated with nerve compression or irritation. ESIs are commonly used for radicular pain stemming from conditions such as disc herniation or spinal stenosis ¹.
Facet Joint Injections: Facet joints are joints that connect adjacent segments of the spine, these joints can become a source of pain due to arthritis or injury. Facet joint injections deliver local anesthetic and or steroid medications directly into the affected joints to alleviate pain and improve mobility. These injections can also serve a diagnostic purpose by confirming the facet joints as the pain source ².
Radiofrequency Ablation (RFA): RFA, also known as radiofrequency neurotomy, is a minimally invasive procedure that uses heat generated by radiofrequency waves to deactivate nerves responsible for transmitting pain signals from the facet joints or sacroiliac joints. By disrupting the nerve’s ability to transmit pain, RFA provides long-lasting relief for patients with chronic low back pain ².
Sacroiliac Joint Injections: Sacroiliac joint dysfunction can cause significant low back and buttock pain. Sacroiliac joint injections deliver a combination of local anesthetic and steroid medication into the joint to reduce inflammation and alleviate pain. These injections can help confirm the sacroiliac joint as the pain source and provide therapeutic relief³.
Trigger point injections: Trigger point injection therapy also known as wet needling or intramuscular stimulation, aims to alleviate pain and dysfunction by targeting hyperirritable areas within muscle tissue, known as trigger points. These trigger points are believed to contribute to low back pain by causing muscle tension, stiffness, and referred pain patterns. The injection of a solution into these trigger points helps to relax them, providing pain relief and restoring muscle function ⁴.