RANDOMIZED CONTROLLED TRIALS IN INDUSTRIAL LOW-BACK-PAIN RELATING TO RETURN TO WORK .2. DISCOGENIC LOW-BACK-PAIN

The purpose of this review was to determine the efficacy of treatments for discogenic low back pain (LBP) by examining all randomized contro lled trials (RCTs) of discogenic LBP published in the English language literature between 1975 and 1993 with ''return to work'' (RTW) as the end point. From more than 4,000 LBP citations, nearly 600 articles we re initially reviewed; 35 studies met our selection criteria. Twenty-t wo studies were discussed in Part 1 (Acute Interventions) or will be d iscussed in Part 3 (Chronic Interventions). In this review, of 13 RCTs assessing interventions for LBP with sciatica, 9 were appropriate for their focus on, and radiologic confirmation of, discogenic LBP. The t reatments assessed included chemonucleolysis, surgical discectomy, and epidural steroid injection. A 26-point system to assess the quality o f methodologic rigor was used for each article. Our literature survey found a need for additional studies comparing surgery, conservative ca re, epidural steroids, traction, and other approaches to determine the ir individual effects for RTW after discogenic disease. (C) 1996 by th e American Congress of Rehabilitation Medicine and the American Academ y of Physical Medicine and Rehabilitation