INJECTION TREATMENT IN NON-RADICULAR LOW- BACK-PAIN

Low back pain is the most expensive condition in industrialized countr ies. Approximately 65-80 % of the population will be afflicted with lo w back pain at some point during their life. Low back pain has many ca uses and can originate from any of several pain-sensitive foci, among which are facet joints, sacroiliac joint, muscle and ligaments. Primar y care in the acute phase consists of nonsteroidal anti-inflammatory d rugs to address the biochemical and inflammatory mediators of pain or skeletal muscle spas molytics to reduce low back pa in symptoms. Injec tion procedures should be reserved for the patients with low back pain who fail to respond to a directed, conservative treatment trial and h ave had pain for at least 2 weeks' duration. Eliminating sensation fro m a certain pain source has been proposed as a way to allow an examine r to determine if that joint is responsible for the patient's pain. In jections of local anesthetic into the facet joint or around its nerve supply are clinical methods of eliminating pain from focal areas such as facet joints or myofascial trigger points. When a particular joint is determined to be the source of pain, long-term relief can be sought by directing therapeutic interventions at that joint. The anatomic ac cessibility of the most common pain sources of low back pain make diag nostic blocks and therapeutic instillation of corticosteroids particul arly appealing. If used, their potential benefit for the individual ca se needs to be carefully weighed. They should be used to facilitate mo re aggressive conservative care and not as an isolated treatment. Cert ainly, if response to corticosteroids does not occur after the first i njection, no further administration of corticosteroids is indicated.