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Treatment of Discogenic Low Back Pain: Current Treatment Strategies and Future Options—a Literature Review

  • Other Pain (N Vadivelu and AD Kaye, Section Editors)
  • Published:
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Abstract

Purpose of Review

Many studies have demonstrated that discogenic low back pain is the most common type of chronic low back pain (CLBP), one of the major causes of disability, and has a major socioeconomic impact. Our aim is to review present therapeutic interventions for discogenic low back pain.

Recent Findings

There are a multitude of treatments used in clinical practice to treat CLBP, but there is continued debate and lack of consensus among clinicians and the policy makers as to which modality is the best approach. Based on controlled evaluations, lumbar intervertebral discs have been shown to be the source of chronic back pain without disc herniation in 26 to 39% of patients. Treatment modalities include noninvasive treatments such as drug therapy, multiple physical modalities, and multidisciplinary biopsychosocial rehabilitation; interventional modalities such as intradiscal therapies and epidural injections; and regenerative modalities with disc injections of various solutions; and, finally, surgical approaches such as fusion and artificial disc replacement, all of which are accompanied by significant discussion, limited evidence, and lack of consensus.

Summary

The results of this evaluation show that the evidence for drug therapy in chronic discogenic low back pain is limited; for multidisciplinary biopsychosocial rehabilitation, it is moderate; and for multiple physical and behavioral therapies, the evidence is limited. For intradiscal therapies, it is poor; for epidural injections, it is moderate; and for regenerative therapies, evidence levels of 3 to 4. The evidence for surgical fusions and disc replacement is similar, without superiority when compared with multidisciplinary biopsychosocial rehabilitation, well-designed physical therapy, or epidural injections.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. US Burden of Disease Collaborators. The state of US health, 1999–2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310:591–608.

    Article  PubMed Central  CAS  Google Scholar 

  2. Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73:968–74.

    Article  PubMed  Google Scholar 

  3. Dieleman JL, Baral R, Birger M, Bui AL, Bulchis A, Chapin A, et al. US spending on personal health care and public health, 1996–2013. JAMA. 2016;316:2627–46.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Geurts JW, Willems PC, Kallewaard JW, van Kleef M, Dirksen C. The impact of chronic discogenic low back pain: costs and patients’ burden. Pain Res Manag. 2018;2018:4696180.

    Article  PubMed  PubMed Central  Google Scholar 

  5. • Manchikanti L, Soin A, Benyamin RM, Singh V, Falco FJ, Calodney AK, et al. An update of the systematic appraisal of the accuracy and utility of discography in chronic spinal pain. Pain Physician. 2018;21:91–110 Important update on discography in chronic spinal pain.

    Article  PubMed  Google Scholar 

  6. • Manchikanti L, Staats PS, Nampiaparampil DE, Hirsch JA. What is the role of epidural injections in the treatment of lumbar discogenic pain: a systematic review of comparative analysis with fusion and disc arthroplasty. Korean J Pain. 2015;28:75–87 Important review on the role of epidurals in lumbar discogenic pain.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. • Manchikanti L, Pampati V, Benyamin RM, Boswell MV. Analysis of efficacy differences between caudal and lumbar interlaminar epidural injections in chronic lumbar axial discogenic pain: local anesthetic alone vs. local combined with steroids. Int J Med Sci. 2015;12:214–22 Important analysis of efficacy between caudal and lumbar interlaminar injections in discogenic pain.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Manchikanti L, Hirsch JA. An update on the management of chronic lumbar discogenic pain. Pain Manag. 2015;5:373–86.

    Article  PubMed  Google Scholar 

  9. • Helm S 2nd, Simopoulos TT, Stojanovic MP, Abdi S, El Terany MA. Effectiveness of thermal annular procedures in treating discogenic low back pain. Pain Physician. 2017;20:447–70 Important review on thermal annular procedures for discogenic low back pain.

    Article  Google Scholar 

  10. Sanapati J, Manchikanti L, Atluri S, Jordan S, Albers SL, Pappolla MA, et al. Do regenerative medicine therapies provide long-term relief in chronic low back pain: a systematic review and metaanalysis. Pain Physician. 2018;21:515–40.

    PubMed  Google Scholar 

  11. Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine (Phila Pa 1976). 2011;36:E825–46.

    Article  Google Scholar 

  12. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine (Phila Pa 1976). 2012;37:67–76.

    Article  Google Scholar 

  13. Phillips FM, Slosar PJ, Youssef JA, Andersson G, Papatheofanis F. Lumbar spine fusion for chronic low back pain due to degenerative disc disease: a systematic review. Spine (Phila Pa 1976). 2013;38:E409–22.

    Article  Google Scholar 

  14. Bydon M, De la Garza-Ramos R, Macki M, Baker A, Gokaslan AK, Bydon A. Lumbar fusion versus nonoperative management for treatment of discogenic low back pain: a systematic review and meta-analysis of randomized controlled trials. J Spinal Disord Tech. 2014;27:297–304.

    Article  PubMed  Google Scholar 

  15. Saltychev M, Eskola M, Laimi K. Lumbar fusion compared with conservative treatment in patients with chronic low back pain: a meta-analysis. Int J Rehabil Res. 2014;37:2–8.

    Article  PubMed  Google Scholar 

  16. Manchikanti L, Kaye AM, Knezevic NN, McAnally H, Trescot AM, Blank S, et al. Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician. 2017;20:S3–92.

    Article  PubMed  Google Scholar 

  17. Sanger N, Bhatt M, Singhal N, Ramsden K, Baptist-Mohseni N, Panesar B, et al. Adverse outcomes associated with prescription opioids for acute low back pain: a systematic review and meta-analysis. Pain Physician. 2019;22:119–38.

    PubMed  Google Scholar 

  18. Navani A, Manchikanti L, Albers SL, Latchaw RE, Sanapati J, Kaye AD, et al. Responsible, safe, and effective use of biologics in the management of low back pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician. 2019;22:S1–S74.

    Article  PubMed  Google Scholar 

  19. Manchikanti L, Sanapati J, Benyamin RM, Atluri S, Kaye AD, Hirsch JA. Reframing the prevention strategies of the opioid crisis: focusing on prescription opioids, fentanyl, and heroin epidemic. Pain Physician. 2018;21:309–26.

    Article  PubMed  Google Scholar 

  20. Chakravarthy K, Manchikanti L, Kaye AD, Christo PJ. Reframing the role of neuromodulation therapy in the chronic pain treatment paradigm. Pain Physician. 2018;21:507–13.

    PubMed  Google Scholar 

  21. Manchikanti L, Soin A, Mann DP, Bakshi S, Pampati V, Hirsch JA. Reversal of growth of utilization of interventional techniques in managing chronic pain in Medicare population post Affordable Care Act. Pain Physician. 2017;20:551–67.

    Article  PubMed  Google Scholar 

  22. Manchikanti L, Soin A, Mann DP, Bakshi S, Pampai V, Hirsch JA. Comparative analysis of utilization of epidural procedures in managing chronic pain in the Medicare population: pre and post Affordable Care Act. Spine (Phila Pa 1976). 2019;44:220–32.

    Article  Google Scholar 

  23. Manchikanti L, Pampati V, Benyamin RM, Hirsch JA. Declining utilization of percutaneous epidural adhesiolysis in Medicare population: evidence-based or over-regulated? IPM Reports. 2018;2:9–18.

    Google Scholar 

  24. Manchikanti MV, Manchikanti L, Kaye AD, Pampati V, Hirsch JA. Usage patterns of sacroiliac joint injections – a comparative evaluation of pre and post Affordable Care Act in Medicare population. IPM Reports. 2018;2:157–66.

    Google Scholar 

  25. Manchikanti L, Pampati V, Benyamin RM, Hirsch JA. Cost calculation methodology exacerbates site-of-service differentials by 10- to 18-fold for soft tissue and joint injections in hospital outpatient departments. IPM Reports. 2017;1:183–9.

    Google Scholar 

  26. Manchikanti L, Singh V, Benyamin RM, Kaye AD, Pampati V, Hirsch JA. Reframing Medicare physician payment policy for 2019: a look at proposed policy. Pain Physician. 2018;21:415–32.

    Article  PubMed  Google Scholar 

  27. • Manchikanti L, Knezevic NN, Boswell MV, Kaye AD, Hirsch JA. Epidural injections for lumbar radiculopathy and spinal stenosis: a comparative systematic review and meta-analysis. Pain Physician. 2016;19:E365–410 Systematic review on epidural injections for spinal stenosis and lumbar radiculopathy.

    Article  PubMed  Google Scholar 

  28. Manchikanti L, Nampiaparampil DE, Manchikanti KN, Falco FJE, Singh V, Benyamin RM, et al. Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: a systematic review of randomized controlled trials. Surg Neurol Int. 2015;6:S194–235.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Manchikanti L, Kaye AD, Manchikanti KN, Boswell MV, Pampati V, Hirsch JA. Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: a systematic review. Anesth Pain Med. 2015;5:e23139.

    PubMed  PubMed Central  Google Scholar 

  30. Chou R, Hashimoto R, Friedly J, Fu R, Bougatsos C, Dana T, et al. Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis. Ann Intern Med. 2015;163:373–81.

    Article  PubMed  Google Scholar 

  31. Lewis RA, Williams NH, Sutton AJ, Burton K, Din NU, Matar HE, et al. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine J. 2015;15:1461–77.

    Article  PubMed  Google Scholar 

  32. Guo JR, Jin XJ, Shen HC, Wang H, Zhou X, Liu XQ, et al. A comparison of the efficacy and tolerability of the treatments for sciatica: a network meta-analysis. Ann Pharmacother. 2017;51:1041–52.

    Article  CAS  PubMed  Google Scholar 

  33. • Manchikanti L, Boswell MV, Kaye AD, Helm S II, Hirsch JA. Therapeutic role of placebo: evolution of a new paradigm in understanding research and clinical practice. Pain Physician. 2017;20:363–86 Role of placebo in research and clinical practice.

    PubMed  Google Scholar 

  34. Lee JH, Kim DH, Kim DH, Shin KH, Park SJ, Lee GJ, et al. Comparison of clinical efficacy of epidural injection with or without steroid in lumbosacral disc herniation: a systematic review and meta-analysis. Pain Physician. 2018;21:449–68.

    Article  PubMed  Google Scholar 

  35. Lee JH, Shin KH, Park SJ, Lee GJ, Lee CH, Kim DH, et al. Comparison of clinical efficacy between transforaminal and interlaminar epidural injections in lumbosacral disc herniation: a systematic review and meta-analysis. Pain Physician. 2018;21:433–48.

    Article  PubMed  Google Scholar 

  36. Shen J, Xu S, Xu S, Ye S, Hao J. Fusion or not for degenerative lumbar spinal stenosis: a meta-analysis and systematic review. Pain Physician. 2018;21:1–8.

    PubMed  Google Scholar 

  37. Song D, He A, Xu R, Xiu X, Wei Y. Efficacy of pain relief in different postherpetic neuralgia therapies: a network meta-analysis. Pain Physician. 2018;21:19–32.

    PubMed  Google Scholar 

  38. Manchikanti L, Malla Y, Cash KA, Pampati V, Hirsch JA. Comparison of effectiveness for fluoroscopic cervical interlaminar epidural injections with or without steroid in cervical post-surgery syndrome. Korean J Pain. 2018;31:277–88.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Fu X, Tang L, Wang C, Li M, Wu H, Li J, et al. A network meta-analysis to compare the efficacy of steroid and antiviral medications for facial paralysis from Bell’s palsy. Pain Physician. 2018;21:559–69.

    PubMed  Google Scholar 

  40. Hou S, Huh B, Kim HK, Kim KH, Abdi S. Treatment of chemotherapy-induced peripheral neuropathy: systematic review and recommendations. Pain Physician. 2018;21:571–92.

    PubMed  Google Scholar 

  41. Cho JH, Lee JH, Song KS, Hong JY, Joo YS, Lee DH, et al. Treatment outcomes for patients with failed back surgery. Pain Physician. 2017;20:E29–43.

    Article  PubMed  Google Scholar 

  42. Yeh SW, Hong CH, Shih MC, Tam KW, Huang YH. Low-level laser therapy for fibromyalgia: a systematic review and meta-analysis. Pain Physician. 2019;22:241–54.

    PubMed  Google Scholar 

  43. Halpern MT, Fiero MH. Factors influencing receipt of interventional pain management among Medicaid beneficiaries with cancer. Pain Physician. 2019;22:E147–55.

    Article  PubMed  Google Scholar 

  44. Kaye AD, Manchikanti L, Novitch MB, Mungrue IN, Anwar M, Jones MR, et al. Responsible, safe, and effective use of antithrombotics and anticoagulants in patients undergoing interventional techniques: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician. 2019;22:S75–S128.

    Article  PubMed  Google Scholar 

  45. Zhiyong C, Yun T, Hui F, Zhongwei Y, Zhaorui L. Unilateral versus bilateral balloon kyphoplasty for osteoporotic vertebral compression fractures: a systematic review of overlapping meta-analyses. Pain Physician. 2019;22:15–28.

    PubMed  Google Scholar 

  46. Kaye AD, Manchikanti L, Abdi S, Atluri S, Bakshi S, Benyamin R, et al. Efficacy of epidural injections in managing chronic spinal pain: a best evidence synthesis. Pain Physician. 2015;18:E939–E1004.

    Article  PubMed  Google Scholar 

  47. Wagemakers SH, van der Velden JM, Gerlich AS, Hindriks-Keegstra AW, van Dijk JFM, Verhoeff JJC. A systematic review of devices and techniques that objectively measure patients’ pain. Pain Physician. 2019;22:1–13.

    Article  PubMed  Google Scholar 

  48. Vu Tran Z, Ivashchenko A, Brooks L. Sacroiliac joint fusion methodology - minimally invasive compared to screw-type surgeries: a systematic review and meta-analysis. Pain Physician. 2019;22:29–40.

    Article  Google Scholar 

  49. Manchikanti L, Pampati V, Kaye AD, Hirsch JA. Therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain: cost utility analysis based on a randomized controlled trial. Korean J Pain. 2018;31:27–38.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Manchikanti L, Pampati V, Kaye AD, Hirsch JA. Cost utility analysis of cervical therapeutic medial branch blocks in managing chronic neck pain. Int J Med Sci. 2017;14:1307–16.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Wu PF, Li YW, Wang B, Jiang B, Tu ZM, Lv GH. Posterior cervical foraminotomy via full-endoscopic versus microendoscopic approach for radiculopathy: a systematic review and meta-analysis. Pain Physician. 2019;22:41–52.

    PubMed  Google Scholar 

  52. Clark W, Bird P, Gonski P, Diamond TH, Smerdely P, McNeil HP, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2016;388:1408–16.

    Article  PubMed  Google Scholar 

  53. Xiang GH, Tong MJ, Lou C, Zhu SP, Guo WJ, Ke CR. The role of unilateral balloon kyphoplasty for the treatment of patients with OVCFS: a systematic review and meta-analysis. Pain Physician. 2018;21:209–18.

    PubMed  Google Scholar 

  54. Chen X, Guo W, Li Q, Ou Z, Lao Z, Liu Y, et al. Is unilateral percutaneous kyphoplasty superior to bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures? Evidence from a systematic review of discordant meta-analyses. Pain Physician. 2018;21:327–36.

    PubMed  Google Scholar 

  55. Rosian K, Hawlik K, Piso B. Efficacy assessment of radiofrequency ablation as a palliative pain treatment in patients with painful metastatic spinal lesions: a systematic review. Pain Physician. 2018;21:E467–76.

    Article  PubMed  Google Scholar 

  56. Beall DP, Coe JD, McIlduff M, Bloch D, Hornberger J, Warner C, et al. Serious adverse events associated with readmission through one year after vertebral augmentation with either a polyetheretherketone implant or balloon kyphoplasty. Pain Physician. 2017;20:521–8.

    Article  PubMed  Google Scholar 

  57. Capossela S, Schläfli P, Bertolo A, Janner T, Stadler BM, Pötzel T, et al. Degenerated human intervertebral discs contain autoantibodies against extracellular matrix proteins. Eur Cell Mater. 2014;27:251–63.

    Article  CAS  PubMed  Google Scholar 

  58. García-Cosamalón J, del Valle ME, Calavia MG, García-Suárez O, López-Muñiz A, Otero J, et al. Intervertebral disc, sensory nerves and neurotrophins: who is who in discogenic pain? J Anat. 2010;217:1–15.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  59. Peng BG. Pathophysiology, diagnosis, and treatment of discogenic low back pain. World J Orthop. 2013;4:42–52.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Yang G, Liao W, Shen M, Mei H. Insight into neural mechanisms underlying discogenic back pain. J Int Med Res. 2018;46:4427–36.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Manchikanti L, Singh V, Pampati V, Damron K, Barnhill R, Beyer C, et al. Evaluation of the relative contributions of various structures in chronic low back pain. Pain Physician. 2001;4:308–16.

    Article  CAS  PubMed  Google Scholar 

  62. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine (Phila Pa 1976). 1995;20:1878–83.

    Article  CAS  Google Scholar 

  63. DePalma MJ, Ketchum JM, Saullo T. What is the source of chronic low back pain and does age play a role? Pain Med. 2011;12:224–33.

    Article  PubMed  Google Scholar 

  64. Bokov A, Perlmutter O, Aleynik A, Rasteryaeva M, Mlyavykh S. The potential impact of various diagnostic strategies in cases of chronic pain syndromes associated with lumbar spine degeneration. J Pain Res. 2013;6:289–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Verrills P, Nowesenitz G, Barnard A. Prevalence and characteristics of discogenic pain in tertiary practice: 223 consecutive cases utilizing lumbar discography. Pain Med. 2015;16:1490–9.

    Article  PubMed  Google Scholar 

  66. Wolfer L, Derby R, Lee JE, Lee SH. Systematic review of lumbar provocation discography in asymptomatic subjects with a meta-analysis of false-positive rates. Pain Physician. 2008;11:513–38.

    Article  PubMed  Google Scholar 

  67. Peng B, Fu X, Pang X, Li D, Liu W, Gao C, et al. Prospective clinical study on natural history of discogenic low back pain at 4 years of follow-up. Pain Physician. 2012;15:525–32.

    Article  PubMed  Google Scholar 

  68. Kuijpers T, van Middelkoop M, Rubinstein SM, Ostelo R, Verhagen A, Koes BW, et al. A systematic review on the effectiveness of pharmacological interventions for chronic non-specific low-back pain. Eur Spine J. 2011;20:40–50.

    Article  CAS  PubMed  Google Scholar 

  69. Chung JW, Zeng Y, Wong T. Drug therapy for the treatment of chronic nonspecific low back pain: systematic review and meta-analysis. Pain Physician. 2013;16:E685–704.

    Article  PubMed  Google Scholar 

  70. White AP, Arnold PM, Norvell DC, Ecker E, Fehlings MG. Pharmacologic management of chronic low back pain: synthesis of the evidence. Spine (Phila Pa 1976). 2011;36:S131–43.

    Article  Google Scholar 

  71. Chou R, Huffman LH, American Pain Society; American College of Physicians. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147:505–14.

    Article  PubMed  Google Scholar 

  72. Leavitt SB. NSAID dangers may limit pain-relief options. Pain-Topics http://updates.pain-topics.org

  73. Moore A, Wiffen P, Kalso E. Antiepileptic drugs for neuropathic pain and fibromyalgia. JAMA. 2014;312:182–3.

    Article  CAS  PubMed  Google Scholar 

  74. Deyo RA, Von Korff M, Duhrkoop D. Opioids for low back pain. BMJ. 2015;350:g6380.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Manchikanti L, Manchikanti KN, Kaye AD, Kaye AM, Hirsch JA. Challenges and concerns of persistent opioid use in cancer patients. Expert Rev Anticancer Ther. 2018;18:705–18.

    Article  CAS  PubMed  Google Scholar 

  76. van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J. 2011;20:19–39.

    Article  PubMed  Google Scholar 

  77. van Middelkoop M, Rubinstein SM, Verhagen AP, Ostelo RW, Koes BW, van Tulder MW. Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol. 2010;24:193–204.

    Article  PubMed  Google Scholar 

  78. Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for nonspecific low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine (Phila Pa 1976). 2005;30:2153–63.

    Article  CAS  Google Scholar 

  79. Furlan AD, Yazdi F, Tsertsvadze A, Gross A, Van Tulder M, Santaguida L, et al. Complementary and alternative therapies for back pain II. Evid Rep Technol Assess (Full Rep). 2010;194:1–764.

    Google Scholar 

  80. Licciardone JC, Aryal S. Clinical response and relapse in patients with chronic low back pain following osteopathic manual treatment: results from the OSTEOPATHIC trial. Man Ther. 2014;19:541–8.

    Article  PubMed  Google Scholar 

  81. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev. 2014;9:CD000963.

    Google Scholar 

  82. Manchikanti L, Cash KA, McManus CD, Pampati V. Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis or facet joint pain. J Pain Res. 2012;5:381–90.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Manchikanti L, Cash KA, McManus CD, Pampati V, Benyamin RM. A randomized, double-blind, active-controlled trial of fluoroscopic lumbar interlaminar epidural injections in chronic axial or discogenic low back pain: results of 2-year follow-up. Pain Physician. 2013;16:E491–504.

    PubMed  Google Scholar 

  84. Manchikanti L, Singh V, Pampati V, Falco FJE, Hirsch JA. Comparison of the efficacy of caudal, interlaminar, and transforaminal epidural injections in managing lumbar disc herniation: is one method superior to the other? Korean J Pain. 2015;28:11–21.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Manchikanti L, Falco FJE, Pampati V, Cash KA, Benyamin RM, Hirsch JA. Cost utility analysis of caudal epidural injections in the treatment of lumbar disc herniation, axial or discogenic low back pain, central spinal stenosis, and post lumbar surgery syndrome. Pain Physician. 2013;16:E129–43.

    Article  PubMed  Google Scholar 

  86. Pauza KJ, Howell S, Dreyfuss P, Peloza JH, Dawson K, Bogduk N. A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine J. 2004;4:27–35.

    Article  PubMed  Google Scholar 

  87. Freeman BJ, Fraser RD, Cain CM, Hall DJ, Chapple DC. A randomized, double-blind, controlled trial: intradiscal electrothermal therapy versus placebo for the treatment of chronic discogenic low back pain. Spine (Phila Pa 1976). 2005;30:2369–77 discussion 2378.

    Article  Google Scholar 

  88. Kapural L, Vrooman B, Sarwar S, Krizanac-Bengez L, Rauck R, Gilmore C, et al. A randomized, placebo-controlled trial of transdiscal radiofrequency, biacuplasty for treatment of discogenic lower back pain. Pain Med. 2013;14:362–73.

    Article  PubMed  Google Scholar 

  89. Lu Y, Guzman JZ, Purmessur D, Iatridis JC, Hecht AC, Qureshi SA, et al. Nonoperative management of discogenic back pain: a systematic review. Spine (Phila Pa 1976). 2014;39:1314–24.

    Article  Google Scholar 

  90. Desai MJ, Kapural L, Petersohn JD, Vallejo R, Menzies R, Creamer M, et al. A prospective, randomized, multi-center, open-label clinical trial comparing intradiscal biacuplasty to conventional medical management for discogenic lumbar back pain. Spine (Phila Pa 1976). 2016;41:1065–74.

    Article  Google Scholar 

  91. Guo X, Ding WY, Liu L, Yang S. Intradiscal methylene blue injection for discogenic low back pain: a meta-analysis. Pain Pract. 2019;19:118–29.

    Article  PubMed  Google Scholar 

  92. Kallewaard JW, Wintraecken VM, Geurts JW, Willems PC, van Santbrink H, Terwiel CTM, et al. A multicenter randomized controlled trial on the efficacy of intradiscal methylene blue injection for chronic discogenic low back pain: the IMBI study. Pain. 2019;160:945–53.

    Article  CAS  PubMed  Google Scholar 

  93. Vallejo R, Zevallos LM, Lowe J, Benyamin R. Is spinal cord stimulation an effective treatment option for discogenic pain? Pain Pract. 2012;12:194–201.

    Article  PubMed  Google Scholar 

  94. Fleege C, Rickert M, Rauschmann M. The PLIF and TLIF techniques. Indication, technique, advantages, and disadvantages. Orthopade. 2015;44:114–23.

    Article  CAS  PubMed  Google Scholar 

  95. Ohtori S, Koshi T, Yamashita M, Yamauchi K, Inoue G, Suzuki M, et al. Surgical versus nonsurgical treatment of selected patients with discogenic low back pain. Spine (Phila Pa 1976). 2011;36:347–54.

    Article  Google Scholar 

  96. Guo J, Wang Y, Chen ZQ, Liu BW, Yang M, Bai ZL. Effect of radiofrequency versus anterior discectomy and posterior lumbar fixation on discogenic low back pain. J Clin Rehabil Tissue Eng Res. 2007;11:2205–8.

    Google Scholar 

  97. Nakashima H, Kawakami N, Tsuji T, Ohara T, Suzuki Y, Saito T, et al. Adjacent segment disease after posterior lumbar interbody fusion: based on cases with a minimum of 10 years of follow-up. Spine (Phila Pa 1976). 2015;40:E831–41.

    Article  Google Scholar 

  98. Thavaneswaran P, Vandepeer M. Lumbar artificial intervertebral disc replacement: a systematic review. ANZ J Surg. 2014;84:121–7.

    Article  PubMed  Google Scholar 

  99. Jacobs WC, van der Gaag NA, Kruyt MC, Tuschel A, de Kleuver M, Peul WC, et al. Total disc replacement for chronic discogenic low back pain. Spine (Phila Pa 1976). 2012;38:24–36.

    Article  Google Scholar 

  100. Garcia R Jr, Yue JJ, Blumenthal S, Coric D, Patel VV, Leary SP, et al. Lumbar total disc replacement for discogenic low back pain: two-year outcomes of the activL multicenter randomized controlled IDE clinical trial. Spine (Phila Pa 1976). 2015;40:1873–81.

    Article  Google Scholar 

  101. Zagra A, Minoia L, Archetti M, Corriero AS, Ricci K, Teli M, et al. Prospective study of a new dynamic stabilisation system in the treatment of degenerative discopathy and instability of the lumbar spine. Eur Spine J. 2012;21:S83–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedics, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, 250021, China

    Lei Zhao

  2. Pain Management Centers of America, Paducah, KY, USA

    Laxmaiah Manchikanti

  3. Departments of Anesthesiology and Pharmacology, Louisiana State University School of Medicine, 1501 Kings Highway, Shreveport, LA, 71103, USA

    Alan David Kaye

  4. Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WA, USA

    Alaa Abd-Elsayed

Authors
  1. Lei Zhao
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  2. Laxmaiah Manchikanti
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  3. Alan David Kaye
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  4. Alaa Abd-Elsayed
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Correspondence to Alan David Kaye.

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Lei Zhao and Laxmaiah Manchikanti declare no conflict of interest. Dr. Kaye is a speaker for Merck. Dr. Abd-Elsayed is a consultant for Medtronic, StimWave, Avanos and Sollis.

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Zhao, L., Manchikanti, L., Kaye, A.D. et al. Treatment of Discogenic Low Back Pain: Current Treatment Strategies and Future Options—a Literature Review. Curr Pain Headache Rep 23, 86 (2019). https://doi.org/10.1007/s11916-019-0821-x

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  • DOI: https://doi.org/10.1007/s11916-019-0821-x

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