How to Treat Low Back Pain

A Guide for Treating causes of Low Back Pain for Physicians and APPs

1st Edition - November 30, 2024
Editors: Timothy R. Deer, Nomen Azeem
Language: English
Hardback ISBN:
9 7 8 - 0 - 4 4 3 - 1 5 9 6 2 - 6
eBook ISBN:
9 7 8 - 0 - 4 4 3 - 1 5 9 6 3 - 3

How to Treat Low Back Pain: A Guide for Treating Causes of Low Back Pain for Physicians and APPs focuses on current technology and cutting-edge treatment options, all validated… Read more

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How to Treat Low Back Pain: A Guide for Treating Causes of Low Back Pain for Physicians and APPs focuses on current technology and cutting-edge treatment options, all validated by data. Each chapter presents a thorough review of patient selection, procedure technique, and potential adverse complications for each recommended treatment. Written by experts in the field for practitioners and clinicians treating low back pain, and with anatomic artwork and illustrations throughout, the book covers all aspects of lower back pain, the leading cause of disability in developed countries, with the number of people affected worldwide increasing annually.

In recent years, there has been a substantial increase in health care costs to treat low back pain, and most of these treatments simply provide symptomatic relief with few strategies that actually contribute to correcting the underlying cause.

Title of Book
Cover image
Title page
Table of Contents
Copyright
Dedication
Contributors
Foreword
Acknowledgment
Section I. Understanding the pathology of disease
Chapter 1. Normal structures of the lumbar spine
Introduction
Osseous structures
Vertebral body
Pedicles
Laminae
Facet (zygapophyseal) joints
Spinous and transverse processes
Intervertebral discs
Spinal cord and spinal nerves
Vascular structures
Muscles and ligaments
Conclusions
Chapter 2. Obtaining an appropriate history from the low back pain patient
Introduction
Importance of history in the workup of LBP
Benefits of a comprehensive history
The first step in appropriate management
History as a foundational step
Treat the symptoms, not the images
Limitations of imaging
Dimensions of the symptom of low back pain
Paraspinal pain
Direct tenderness to palpation along the spine
Unilateral flank pain
Lateral back pain
Periscapular Pain
Onset of pain
Initial onset of pain
Sudden or gradual onset
Duration of symptoms
Precipitating factors
Similar pain previously?
Character
Describing the quality or character of pain (e.g., dull, sharp, burning)
Radiation
Assessing if pain radiates to other body regions
Pace of illness
Understanding the progression of symptoms
Exacerbating or relieving factors
Identifying factors or movements that worsen or alleviate pain
Severity
Quantifying pain severity using a pain scale
Associated symptoms
Exploring additional symptoms or systemic complaints
Chapter 3. Physical examination
Introduction
General physical examination
Neurologic examination
Motor strength examination
Sensation
Deep tendon reflexes
Coordination
Provocative tests
Lumbar radicular pain
Straight leg raise
Crossed straight leg raise
Femoral stretch test
Discogenic pain/vertebrogenic pain
Zygapophyseal joint
Sacroiliac joint
Chapter 4. Imaging for low back pain
Introduction
Magnetic resonance imaging
Degenerative conditions
Diskogenic pain
Vertebrogenic back pain (Modic endplate changes)
Degenerative spondylolisthesis
Disk herniation
Lumbar stenosis with neurogenic claudication
Lateral recess stenosis
Foraminal stenosis
Synovial cysts
Compression fractures
Spondylolysis
Spine infections
Spine neoplasm
Postoperative back pain conditions
Pseudoarthrosis
CT imaging of low back pain
Physics and image generation
Unique benefits
Limitations
Clinical cases
Ultrasonography
Plain radiographs
Positron emission tomography–computed tomography
Bone scan
Conclusion
Chapter 5. Other diagnostic work up
Overview: Use of electromyography/nerve conduction study
History and background
Science behind diagnostic study
Indication and patient selection
Technique and interpretation
Complication
Pearls and pitfalls
Discography
History and background
Science behind diagnostic study
Indication and patient selection
Pearls and pitfalls
Myelograms
History and background
Science behind diagnostic study
Indication and patient selection
Technique and interpretation
Complications
Pearls and pitfalls
Section II. Conservative treatments
Chapter 6. Physical therapy and exercise
Introduction
History of physical therapy and therapeutic exercise
Clinical course of low back pain
Initial assessment and diagnostic triage
Classifying low back pain
Mechanical Diagnosis and Therapy
Summary and conclusion
Chapter 7. Chiropractic treatment of low back pain
History and background
Science behind treatment
Indication and patient selection
Nociceptive low back pain
Treatments
A typical chiropractic visit
McKenzie exercises
Evidence
Potential complications
Conclusion
Chapter 8. Other conservative treatment
Treatment- overview of acupuncture
Treatment- overview of dry-needling
History and background
Science behind treatment
Indications and patient selection
Technique
Complications
Pearls and pitfalls
Treatment overview of cupping
History & background
Science behind treatment
Indication and patient selection
Technique
Complications
Pearls and pitfalls
Treatment- overview of TENS
History & background
Science behind treatment
Indication and patient selection
Technique
Complications
Pearls and pitfalls
Treatment – overview of biofeedback
History and background
Science behind treatment
Indications and patient selection
Other techniques
Complications
Pearls and pitfalls
Treatment- overview of pain psychology
History & background
Science behind treatment
Indication and patient selection
Technique
Cognitive behavior therapy
Acceptance and commitment therapy
Mindfulness based therapy
Complications
Pearls and pitfalls
Section III. Interventional treatments
Chapter 9. Injections for lumbar pain syndromes
Introduction
Trigger point injections
Background
Anatomy
Indications and contraindications
Technique
Cautions/complications
Efficacy/literature
Lumbar interlaminar epidural injection
Background
Anatomy
Indications and contraindications
Technique
Cautions/complications
Efficacy/literature
Lumbar transforaminal epidural injection
Background
Anatomy
Indications and contraindications
Technique
Cautions/complications
Efficacy/literature
Caudal epidural injection
Background
Anatomy
Indications and contraindications
Technique
Cautions/complications
Efficacy/literature
Intraarticular facet injection
Background
Anatomy
Indications and contraindications
Technique
Cautions/complications
Efficacy/literature
Sacroiliac joint injection
Background
Anatomy
Indications and contraindications
Technique
Cautions/complications
Efficacy/literature
Conclusion
Chapter 10. Radiofrequency ablation of the medial branches
History of radiofrequency ablation of the lumbar facet joints
Anatomy/etiology of facet-mediated pain
Diagnosis
Evidence for treatment
Indications for treatment and patient selection
Techniques
Complications
Clinical pearls and pitfalls in lumbar radiofrequency ablation
Chapter 11. Ablation of the basivertebral nerve
Introduction
Anatomy and pathophysiology
Clinical presentation
Diagnostic imaging
Treatment
Procedure description
Complications
Conclusion
Chapter 12. Intradiscal biologic implants for low back pain
Regenerative therapeutic approaches to treating IVDD
Compositions of PRP and BMC
Role of biochemical factors
Role of cells and extracellular vesicles
Strategies for therapeutic interventions
Conclusion
Nonregenerative therapeutic approaches to treating IVDD
Composition of nucleus pulposus allograft
Strategies for therapeutic interventions
Conclusion
Intradiscal biologic implant technique
Chapter 13. Percutaneous Interlaminar Lumbar decompression (PILD)
Background
History
Science behind treatment
Indication and patient selection
Technique
Perioperative
Procedural technique
Procedural advances
Postoperative
Complications
Pearls and pitfalls
Pearls
Pitfalls
Conclusion
Chapter 14. Interspinous process spacers
History/background
Indications & patient selection
Evidence
Benefits/risks
Technique
Patient positioning
Deploying the implant
Two level implant
Implant removal
Interspinous spacers: The vertiflex option
Pearls and pitfalls
Chapter 15. Minimally invasive spinal arthrodesis
Introduction
Review of current data/evidence
Indications
Contraindications
Current specific implants available
Aurora: Zip
Southern spine: StabiLink
Spinal simplicity: Minuteman
KIC ventures: InSpan
Clinical pearls
Cautions/complications
Conclusions
Chapter 16. Minimally invasive sacroiliac joint fusion for the treatment of sacroiliac joint pain
Background and history
Available devices and clinical evidence
Surgical technique for sacroiliac joint fusion—Posterior approach using a single graft
Lateral approach
Posterolateral (posterior oblique) approach
Complications
Pearls and pitfalls
Chapter 17. Vertebral augmentation
Introduction
Etiology
Pathophysiology
Clinical presentation/physical examination
Diagnosis/differential diagnosis
Conservative management
Vertebroplasty
Vertebroplasty procedure
Kyphoplasty
SpineJack
Review of literature
Indications and contraindications
Procedure technique
Prevention
Conclusion
Section IV. Neurostimulation for low back pain
Chapter 18. Dorsal column spinal cord stimulation (SCS)
Introduction
Anatomy and physiology of the spine relevant to dorsal column stimulation
Indications and contraindications for dorsal column stimulation
Patient selection criteria
Contraindications to dorsal column stimulation
Dorsal column stimulation procedure
Preprocedure preparation
Patent positioning and anesthesia
Implantation of the dorsal column stimulator
Programming and optimization of the device
Results and outcomes of dorsal column stimulation
Efficacy of dorsal column stimulation in treating chronic low back pain
Comparison of dorsal column stimulation to other treatment options
Complication rates and management
Postprocedure care
Monitoring and management of pain and complications
Rehabilitation and optimization of pain relief
Follow-up and maintenance of the dorsal column stimulator
Chapter 19. Dorsal root ganglion stimulation for low back pain
Brief history and background of DRG-S and its application for low back pain
DRG-S mechanism of action
L2 DRG-S for discogenic pain
T12 DRG-S for LBP
Indications and patient selection
Technique
The contralateral approach
The ipsilateral paramedian approach
Complications
Hardware related
Migration and lead fracture
Safety
Pearls and pitfalls
Conclusion
Chapter 20. Peripheral nerve stimulation for chronic low back pain
Introduction/background
Supporting science
Clinical data
Indication/patient selection
Technique
Restorative neurostimulation
Complications
Pearls and pitfalls
Conclusion
Chapter 21. Lumbar multifidus muscle stimulation
History and background
Science behind treatment and evidence (B trial results) (Chris)
Indication and patient selection
Restorative neurostimulator implant—Surgical technique
Preoperative and patient positioning
Imaging and guide needles
Surgical access and fascial entry
Delivery needle and guidewire placement
Introducer sheath and lead placement
Pocket, testing, and closure
Pearls/pitfalls
Complications and management
Section V. Intrathecal therapies for low back pain
Chapter 22. Intrathecal drug infusion system: Long-term opioid management
Background and history
Available implantable devices
MRI compatibility
Intrathecal opioids
Morphine
Hydromorphone
Fentanyl
Sufentanil
Indications and patient selection
Technique
Complications
Pearls and pitfalls
Chapter 23. Nonopioid therapy for intrathecal drug delivery
Introduction
Nonopioid medications for intrathecal use
Current guidelines and recommendations
Factors affecting choice of nonopioid medications
CSF flow dynamics and catheter tip location
Future directions
Chapter 24. The importance of the APP's ability to identify low back pain generators and select patients for appropriate treatment
Introduction
Identifying generators of low back pain
History of present illness
Onset
Location
Duration
Character
Aggravating and relieving factors
Treatment
Severity
Associated symptoms
Red flag presentations
Physical examination
Musculoskeletal exam
Neurological exam
Provocative tests
Imaging
Patient selection for treatment
Conservative treatment
Interventional treatment
Injections
Trigger point injections
Epidural steroid injections
Intraarticular facet steroid injections
Sacroiliac joint injections
Radiofrequency ablation
Lumbar medial branch radiofrequency ablation
Sacroiliac joint radiofrequency ablation
Intradiscal treatment
Vertebral pain treatment
Minimally invasive spine treatment
Sacroiliac joint fusion
Percutaneous image-guided lumbar decompression
Interspinous spacers
Interspinous arthrodesis
Vertebral augmentation (kyphoplasty)
Neuromodulation treatment
Spinal cord stimulation
Peripheral nerve stimulation
Dorsal root ganglion stimulation
Multifidus stimulation
Intrathecal drug delivery treatment
Conclusion
Chapter 25. The importance of the APP in perioperative management of MIS and neuromodulation for low back pain
Introduction
The role of the APP in pre- and postop patient management
Preoperative examination, history and imaging
Patient education
Expectations
Postoperative care
Incision management
Postoperative education
The role of the intraoperative APP
Perioperative management of neuromodulation patient
Patient selection
Medical optimization
Patient education and expectation setting
Post op management
Perioperative management of MIS
Preoperative patient management
Patient selection
Medical optimization
Preoperative imaging
Patient education and expectation setting
Postoperative patient management
Postoperative patient assessment
Wound management
Postoperative activity
Managing postoperative pain
Assessment and treatment of postoperative complications
Conclusion
Index

Timothy R. Deer

Timothy R. Deer is a clinical professor of anesthesiology at the West Virginia University School of Medicine, where he also received his medical degree. He completed his training in anesthesiology and pain medicine at the University of Virginia. Dr. Deer has published on a range of topics, including injection techniques, minimally invasive disc procedures, intrathecal drug delivery, and spinal cord and peripheral nerve stimulation. He lectures at many national and international symposiums and has been involved in the hands-on training of more than a thousand interventional pain specialists. He serves on the board of directors of the North American Neuromodulation Society and American Academy of Pain Medicine. He is a past chair of the committee on pain medicine of the American Society of Anesthesiologists, a member of the editorial board of the journal Neuromodulation, president of the West Virginia Society of Interventional Pain Physicians, and serves on several other boards and committees.

Affiliations and expertise

President and CEO, The Spine and Nerve Centers of the Virginias, USA

Nomen Azeem

Dr. Azeem is an associate assistant professor in the pain/neurology department of the University of South Florida, and actively continues to conduct research and author peer-reviewed publications in addition to treating patients, President, Florida Society of Pain & Neuroscience, Chair of Strategic Development for State Society Engagement and Advocacy, American Society of Pain & Neuroscience and Board of Directors, Florida Prescription Drug Monitoring Foundation. Dr. Azeem served as a board member for the Greater New Orleans Sports Foundation and held the position of director of neuromodulation in a multidisciplinary pain practice in New Orleans before moving to Florida. He recently developed the first successful non-opioid based interventional pain clinic in the Sarasota, Florida, area.

Affiliations and expertise

Founder and CEO, Florida Spine and Pain Specialists, FL, USA

Life Sciences

Physical Sciences & Engineering

Social Sciences & Humanities

Health