Non-surgical Management of Disc-related Low Back Pain: An Algorithmic Approach and Practical Guideline
-
Pardis Noormohammadpour
,
Mohammad Hossein Pourgharib Shahi
,
Shima Ghannadi
,
Mahshid Nazarieh
,
Faezeh Maleklou
,
Fatemeh Ejtehadi
,
Babak Mirzashahi
Abstract
Introduction: Low back pain (LBP) is a common health problem worldwide and the primary cause of years lived with disability. Studies on the non-surgical management approaches for disc-related LBP are sparse and scarce, so a clear and structured guideline in this area would be useful. This study summarizes the non-surgical management approaches for disc-related LBP in a review.
Materials and Methods: Intervention studies and review articles relating to the non-surgical approaches for disc-related LBP treatment were curated from PubMed, EMBASE, Cochrane, and Google Scholar databases before July 1, 2022.
Results: Several management approaches are suggested in the studies for disc-related LBP, including medications, acupuncture, lumbar orthoses, exercise therapy, manual therapy, physical therapy modalities, and spinal injections. Some of these options have been studied more, like exercise therapy and injections, and there are more favorable reports for them. Some others have been less studied and need to be investigated in future studies, like different physical therapy modalities.
Conclusion: Recommendations are based on low- to moderate-quality evidence or consensus in the management approach studies for disc-related LBP. Therefore, the authors recommend intensifying research efforts concerning all aspects of the non-surgical management of LBP.
Institute for Health Metrics and Evaluation. Findings from the global burden of disease study 2017. London: The Lancet; 2018. [Link]
Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, =. What low back pain is and why we need to pay attention. Lancet. 2018; 391(10137):2356-67. [DOI:10.1016/S0140-6736(18)30480-X] [PMID]
Brinjikji W, Diehn FE, Jarvik JG, Carr CM, Kallmes DF, Murad MH, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: A systematic review and meta-analysis. AJNR. American Journal of Neuroradiology. 2015; 36(12):2394-9. [DOI:10.3174/ajnr.A4498] [PMID] [PMCID]
Zhao L, Manchikanti L, Kaye AD, Abd-Elsayed A. Treatment of discogenic low back pain: Current treatment strategies and future options-a literature review. Current Pain and Headache Reports. 2019; 23(11):86. [DOI:10.1007/s11916-019-0821-x] [PMID]
Sharafi SE, Hafizi S, Shahi MH, Kordi R, Noorbala AA, Arbabi M, et al. The Persian version of Örebro musculoskeletal pain screening questionnaire: Translation and evaluation of its psychometric properties. International Journal of Preventive Medicine. 2017; 8:14. [DOI:10.4103/2008-7802.201658] [PMID] [PMCID]
Fardon DF. Nomenclature and classification of lumbar disc pathology. Spine. 2001; 26(5):461-2. [DOI:10.1097/00007632-200103010-00006] [PMID]
Mo Z, Li D, Zhang R, Chang M, Yang B, Tang S. Comparisons of the effectiveness and safety of tuina, acupuncture, traction, and Chinese herbs for lumbar disc herniation: A systematic review and network meta-analysis. Evidence-Based Complementary and Alternative Medicine. 2019; 2019:6821310. [DOI:10.1155/2019/6821310] [PMID] [PMCID]
Liu CH, Kung YY, Lin CL, Yang JL, Wu TP, Lin HC, et al. Therapeutic efficacy and the impact of the "dose" effect of acupuncture to treat sciatica: A randomized controlled pilot study. Journal of Pain Research. 2019; 12:3511-20. [DOI:10.2147/JPR.S210672] [PMID] [PMCID]
Tang S, Mo Z, Zhang R. Acupuncture for lumbar disc herniation: A systematic review and meta-analysis. Acupuncture in Medicine. 2018; 36(2):62-70. [DOI:10.1136/acupmed-2016-011332] [PMID]
Tavakol Z, Shariat A, Ansari NN, Ghannadi S, Honarpishe R, Dommerholt J, et al. A double-blind randomized controlled trial for the effects of dry needling on upper limb dysfunction in patients with stroke. Acupuncture & Electro-Therapeutics Research. 2021; 45(2-3):115-24. [DOI:10.3727/036012921X16112663844923]
Fujii K, Yamazaki M, Kang JD, Risbud MV, Cho SK, Qureshi SA, et al. Discogenic back pain: Literature review of definition, diagnosis, and treatment. JBMR Plus. 2019; 3(5):e10180. [DOI:10.1002/jbm4.10180] [PMID] [PMCID]
Zhou W, Benharash P. Effects and mechanisms of acupuncture based on the principle of meridians. Journal of Acupuncture and Meridian Studies. 2014; 7(4):190-3. [DOI:10.1016/j.jams.2014.02.007] [PMID]
Sun J, Wang Y, Zhang Z, Cao H, Wang P, Zhao M, et al. [Effects of needling depth on clinical efficacy of lumbar disc herniation: A systematic review (Chinese)]. Zhongguo Zhen Jiu. 2017; 37(9):1015-20. [DOI:10.13703/j.0255-2930.2017.09.029] [PMID]
Li X, Han Y, Cui J, Yuan P, Di Z, Li L. Efficacy of warm needle moxibustion on lumbar disc herniation: A meta-analysis. Journal of Evidence-Based Complementary & Alternative Medicine. 2016; 21(4):311-9. [DOI:10.1177/2156587215605419] [PMID]
Stochkendahl MJ, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen M, et al. National clinical guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. European spine Journal. 2018; 27(1):60-75. [DOI:10.1007/s00586-017-5099-2] [PMID]
Munoz F, Salmochi JF, Faouën P, Rougier P. Low back pain sufferers: Is standing postural balance facilitated by a lordotic lumbar brace? Orthopaedics & Traumatology, Surgery & Research. 2010; 96(4):362-6. [DOI:10.1016/j.otsr.2010.01.003] [PMID]
Prateepavanich P, Thanapipatsiri S, Santisatisakul P, Somshevita P, Charoensak T. The effectiveness of lumbosacral corset in symptomatic degenerative lumbar spinal stenosis. Journal of the Medical Association of Thailand. 2001; 84(4):572-6. [PMID]
Rostami M, Noormohammadpour P, Sadeghian AH, Mansournia MA, Kordi R. The effect of lumbar support on the ultrasound measurements of trunk muscles: A single-blinded randomized controlled trial. PM & R. 2014; 6(4):302-8. [DOI:10.1016/j.pmrj.2013.09.014] [PMID]
Choo YJ, Chang MC. Effectiveness of orthoses for treatment in patients with spinal pain. Yeungnam University Journal of Medicine. 2020; 37(2):84-9. [DOI:10.12701/yujm.2020.00150] [PMID] [PMCID]
Rasmussen-Barr E, Held U, Grooten WJA, Roelofs PDDM, Koes BW, van Tulder MW, et al. Nonsteroidal anti-inflammatory drugs for sciatica: An updated cochrane review. Spine. 2017; 42(8):586-94. [DOI:10.1097/BRS.0000000000002092] [PMID]
Manchikanti L, Hirsch JA. An update on the management of chronic lumbar discogenic pain. Pain Management. 2015; 5(5):373-86. [DOI:10.2217/pmt.15.33] [PMID]
Rasmussen-Barr E, Held U, Grooten WJ, Roelofs PD, Koes BW, van Tulder MW, et al. Non-steroidal anti-inflammatory drugs for sciatica. The Cochrane Database of Systematic Reviews. 2016; 10(10):CD012382. [DOI:10.1002/14651858.CD012382] [PMID] [PMCID]
Kataria D, Jumani L, Ahmed MU, Kumar V, Makda A. Comparison of pregabalin versus placebo in reduction of pain due to lumber disc herniation. Cureus. 2020; 12(8):e9985. [DOI:10.7759/cureus.9985]
Goldberg H, Firtch W, Tyburski M, Pressman A, Ackerson L, Hamilton L, et al. Oral steroids for acute radiculopathy due to a herniated lumbar disk: A randomized clinical trial. JAMA. 2015; 313(19):1915-23. [DOI:10.1001/jama.2015.4468] [PMID] [PMCID]
Keynan O, Mirovsky Y, Dekel S, Gilad VH, Gilad GM. Safety and efficacy of dietary agmatine sulfate in lumbar disc-associated radiculopathy. An open-label, dose-escalating study followed by a randomized, double-blind, placebo-controlled trial. Pain Medicine. 2010; 11(3):356-68. [DOI:10.1111/j.1526-4637.2010.00808.x] [PMID]
Gadjradj PS, Arts MP, van Tulder MW, Rietdijk WJR, Peul WC, Harhangi BS. Management of symptomatic lumbar disk herniation: An international perspective. Spine. 2017; 42(23):1826-34. [DOI:10.1097/BRS.0000000000002294] [PMID]
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. The Spine Journal. 2015; 15(6):1461-77. [DOI:10.1016/j.spinee.2013.08.049] [PMID]
Kreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy.The Spine Journal. 2014; 14(1):180-91. [DOI:10.1016/j.spinee.2013.08.003] [PMID]
Bakhtiary AH, Safavi-Farokhi Z, Rezasoltani A. Lumbar stabilizing exercises improve activities of daily living in patients with lumbar disc herniation. Journal of Back and musculoskeletal Rehabilitation. 2005; 18(3-4):55-60. [DOI:10.3233/BMR-2005-183-401]
Żurawski A, Kiebzak W, Zmyślna A, Pogożelska J, Kotela I, Kowalski TJ, et al. Efficacy of the use of the McKenzie and Vojta methods to treat discopathy-associated syndromes in the pediatric population. International Journal of Occupational Medicine and Environmental Health. 2019; 32(1):33-41. [DOI:10.13075/ijomeh.1896.01309] [PMID]
Kennedy DJ, Noh MY. The role of core stabilization in lumbosacral radiculopathy. Physical Medicine and Rehabilitation Clinics of North America. 2011; 22(1):91-103. [DOI:10.1016/j.pmr.2010.12.002] [PMID]
Noormohammadpour P, Kordi M, Mansournia MA, Akbari-Fakhrabadi M, Kordi R. The role of a multi-step core stability exercise program in the treatment of nurses with chronic low back pain: A single-blinded randomized controlled trial. Asian Spine Journal. 2018; 12(3):490-502. [DOI:10.4184/asj.2018.12.3.490] [PMID] [PMCID]
Alizadeh R, Shariat A, Ansari NN, Kordi R, Cleland JA, Hakakzadeh A, et al. Office-based exercise therapy as a non-pharmacological treatment for discogenic low back pain among army staff. Iranian Journal of Public Health. 2018; 47(12):1969-70. [Link]
Hahne AJ, Ford JJ, McMeeken JM. Conservative management of lumbar disc herniation with associated radiculopathy: A systematic review. Spine. 2010; 35(11):E488-504. [DOI:10.1097/BRS.0b013e3181cc3f56] [PMID]
Akuthota V, Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. Current Sports Medicine Reports. 2008; 7(1):39-44. [DOI:10.1097/01.CSMR.0000308663.13278.69] [PMID]
Noormohammadpour P, Hosseini Khezri A, Linek P, Mansournia MA, Hassannejad A, Younesian A, et al. Comparison of lateral abdominal muscle thickness and cross sectional area of multifidus in adolescent soccer players with and without low back pain: A case control study. Asian Journal of Sports Medicine. 2016; 7(4):e38318. [DOI:10.5812/asjsm.38318] [PMID] [PMCID]
Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine. 1996; 21(22):2640-50. [DOI:10.1097/00007632-199611150-00014] [PMID]
Shamsi MB, Sarrafzadeh J, Jamshidi A. Comparing core stability and traditional trunk exercise on chronic low back pain patients using three functional lumbopelvic stability tests. Physiotherapy Theory and Practice. 2015; 31(2):89-98. [DOI:10.3109/09593985.2014.959144] [PMID]
Sadeghi H, Shariat A, Asadmanesh E, Mosavat M. The Effects of core stability exercise on the dynamic balance of volleyball players. International Journal of Applied Exercise Physiology. 2013; 2(2):1-10. [Link]
Moghadam N, Ghaffari MS, Noormohammadpour P, Rostami M, Zarei M, Moosavi M, et al. Comparison of the recruitment of transverse abdominis through drawing-in and bracing in different core stability training positions. Journal of Exercise Rehabilitation. 2019; 15(6):819-25. [DOI:10.12965/jer.1939064.352] [PMID] [PMCID]
Kim YS, Park J, Shim JK. Effects of aquatic backward locomotion exercise and progressive resistance exercise on lumbar extension strength in patients who have undergone lumbar diskectomy. Archives of Physical Medicine and Rehabilitation. 2010; 91(2):208-14. [DOI:10.1016/j.apmr.2009.10.014] [PMID]
Khanzadeh R, Mahdavinejad R, Borhani A. The effect of suspension and conventional core stability exercises on characteristics of intervertebral disc and chronic pain in office staff due to lumbar herniated disc. The Archives of Bone and Joint Surgery. 2020; 8(3):445-53. [DOI:10.22038/abjs.2019.40758.2102] [PMID] [PMCID]
Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: Systematic review and meta-analysis of randomised controlled trials. BMJ. 2019; 364:l689. [DOI:10.1136/bmj.l689] [PMID] [PMCID]
Satpute K, Hall T, Bisen R, Lokhande P. The effect of spinal mobilization with leg movement in patients with lumbar radiculopathy-A double-blind randomized controlled trial. Archives of Physical Medicine and Rehabilitation. 2019; 100(5):828-36. [DOI:10.1016/j.apmr.2018.11.004] [PMID]
Bello B, Danazumi MS, Kaka B. Comparative effectiveness of 2 manual therapy techniques in the management of lumbar radiculopathy: A randomized clinical trial. Journal of Chiropractic Medicine. 2019; 18(4):253-60. [DOI:10.1016/j.jcm.2019.10.006] [PMID] [PMCID]
Mo Z, Zhang R, Chen J, Shu X, Shujie T. Comparison between oblique pulling spinal manipulation and other treatments for lumbar disc herniation: A systematic review and meta-analysis. Journal of Manipulative and Physiological Therapeutics. 2018; 41(9):771-9. [DOI:10.1016/j.jmpt.2018.04.005] [PMID]
Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Annals of Internal Medicine. 2003; 138(11):871-81. [DOI:10.7326/0003-4819-138-11-200306030-00008] [PMID]
Efstathiou MA, Stefanakis M, Savva C, Giakas G. Effectiveness of neural mobilization in patients with spinal radiculopathy: A critical review. Journal of Bodywork and Movement Therapies. 2015; 19(2):205-12. [DOI:10.1016/j.jbmt.2014.08.006] [PMID]
Oláh M, Molnár L, Dobai J, Oláh C, Fehér J, Bender T. The effects of weightbath traction hydrotherapy as a component of complex physical therapy in disorders of the cervical and lumbar spine: A controlled pilot study with follow-up. Rheumatology International. 2008; 28(8):749-56. [DOI:10.1007/s00296-008-0522-y] [PMID]
Lisi AJ. The centralization phenomenon in chiropractic spinal manipulation of discogenic low back pain and sciatica. Journal of Manipulative and Physiological Therapeutics. 2001; 24(9):596-602. [DOI:10.1067/mmt.2001.118986] [PMID]
Fronczyk K, Kuliński W. Lumbosacral discopathy: Analysis of physical therapy. Medical Studies/Studia Medyczne. 2017; 33(1):9-16. [DOI:10.5114/ms.2017.66950]
Krawczyk–Suszek M, Szlichta–Kołeczek K, Bednarski J. Efficacy of rehabilitation in patients with segmental discopathy lumbar-sacral spine. World Scientific News. 2018; 111:40-50. [Link]
Johnson M, Martinson M. Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: A meta-analysis of randomized controlled trials. Pain. 2007; 130(1-2):157-65.[DOI:10.1016/j.pain.2007.02.007] [PMID]
Fuentes JP, Armijo Olivo S, Magee DJ, Gross DP. Effectiveness of interferential current therapy in the management of musculoskeletal pain: A systematic review and meta-analysis. Physical Therapy. 2010; 90(9):1219-38. [DOI:10.2522/ptj.20090335] [PMID]
Noori SA, Rasheed A, Aiyer R, Jung B, Bansal N, Chang KV, et al. Therapeutic ultrasound for pain management in chronic low back pain and chronic neck pain: A systematic review. Pain Medicine. 2020; 21(7):1482-93. [DOI:10.1093/pm/pny287]
Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. The Cochrane Database of Systematic Reviews. 2008; 2008(4):CD003008. [DOI:10.1002/14651858.CD003008.pub3] [PMID] [PMCID]
Tavakol Z, Shariat A, Ghannadi S, Ansari NN, Ingle L, Honarpishe R, et al. Effect of intensive neuromuscular electrical stimulation on chronic neck pain: A case report. Journal of Pain Management. 2019; 12(2):173-7. [Link]
Ratajczak B, Hawrylak A, Demidaś A, Kuciel-Lewandowska J, Boerner E. Effectiveness of diadynamic currents and transcutaneous electrical nerve stimulation in disc disease lumbar part of spine. Journal of Back and Musculoskeletal Rehabilitation. 2011; 24(3):155-9. [DOI:10.3233/BMR-2011-0289] [PMID]
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. European Spine Journal. 2011; 20(1):19-39. [DOI:10.1007/s00586-010-1518-3] [PMID] [PMCID]
Wang L, Fan W, Yu C, Lang M, Sun G. Clinical effects of electrical stimulation therapy on lumbar disc herniation-induced sciatica and its influence on peripheral ROS level. Journal of Musculoskeletal & Neuronal Interactions. 2018; 18(3):393-8. [PMID] [PMCID]
Sayilir S, Yildizgoren MT. The medium-term effects of diadynamic currents in chronic low back pain; TENS versus diadynamic currents: A randomised, follow-up study. Complementary Therapies in Clinical Practice. 2017; 29:16-9. [DOI:10.1016/j.ctcp.2017.07.002] [PMID]
Rajfur J, Pasternok M, Rajfur K, Walewicz K, Fras B, Bolach B, et al. Efficacy of selected electrical therapies on chronic low back pain: A comparative clinical pilot study. Medical Science Monitor. 2017; 23:85-100. [DOI:10.12659/MSM.899461] [PMID] [PMCID]
Palmer S, Martin D. Interferential current for pain control. In: Kitchen S, editor. Electrotherapy: Evidence-based practice. Edinburgh: Churchill Livingstone; 2002. [Link]
Robertson V, Ward A, Low J, Reed A. Electrotherapy explained: Principles and practice. Edinburgh: Elsevier Health Sciences; 2006. [Link]
Döhnert MB. Interferential current combined with lumbopelvic stabilization exercises in patients with degenerative disc disease with symptoms of chronic low back pain. EC Orthopaedics. 2016; 3:335-44. [Link]
Albornoz-Cabello M, Maya-Martín J, Domínguez-Maldonado G, Espejo-Antúnez L, Heredia-Rizo AM. Effect of interferential current therapy on pain perception and disability level in subjects with chronic low back pain: A randomized controlled trial. Clinical Rehabilitation. 2017; 31(2):242-9. [DOI:10.1177/0269215516639653] [PMID]
Ariel E, Levkovitz Y, Goor-Aryeh I, Motti R. The effects of TENS, interferential stimulation, and combined interferential stimulation and pulsed ultrasound on patients with disc herniation-induced radicular pain. Journal of Back and Musculoskeletal Rehabilitation. 2022; 35(2):363-71. [DOI:10.3233/BMR-200302] [PMID]
Yousefi-Nooraie R, Schonstein E, Heidari K, Rashidian A, Pennick V, Akbari-Kamrani M, et al. Low level laser therapy for nonspecific low-back pain. The Cochrane Database of Systematic Reviews. 2008; 2008(2):CD005107. [DOI:10.1002/14651858.CD005107.pub4] [PMID] [PMCID]
Unlu Z, Tasci S, Tarhan S, Pabuscu Y, Islak S. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. Journal of Manipulative and Physiological Therapeutics. 2008; 31(3):191-8. [DOI:10.1016/j.jmpt.2008.02.001] [PMID]
Song HJ, Seo HJ, Lee Y, Kim SK. Effectiveness of high-intensity laser therapy in the treatment of musculoskeletal disorders: A systematic review and meta-analysis of randomized controlled trials. Medicine. 2018; 97(51):e13126. [DOI:10.1097/MD.0000000000013126] [PMID] [PMCID]
Chen L, Liu D, Zou L, Huang J, Chen J, Zou Y, et al. Efficacy of high intensity laser therapy in treatment of patients with lumbar disc protrusion: A randomized controlled trial. Journal of Back and Musculoskeletal Rehabilitation. 2018; 31(1):191-6. [DOI:10.3233/BMR-170793] [PMID]
Boyraz I, Yildiz A, Koc B, Sarman H. Comparison of high-intensity laser therapy and ultrasound treatment in the patients with lumbar discopathy. BioMed Research International. 2015; 2015:304328. [DOI:10.1155/2015/304328] [PMID] [PMCID]
van der Windt DAWM, van der Heijden GJMG, van den Berg SGM, Ter Riet G, de Winter AF, Bouter LM. Ultrasound therapy for musculoskeletal disorders: A systematic review. Pain. 1999; 81(3):257-71. [DOI:10.1016/S0304-3959(99)00016-0] [PMID]
Noormohammadpour P, Aghaei-Afshar M, Mansournia MA, Mirzashahi B, Akbari-Fakhrabadi M, Linek P, et al. The relationship between low back pain incidence and ultrasound assessment of trunk muscles in adult soccer players: A cohort study. Asian Journal of Sports Medicine. 2020; 11(2):e102810. [DOI:10.5812/asjsm.102810]
Barati AH, Shoja’Aldin S, Karami M, Pourgharib-Shahi MH, Haghighi M. [Identifying base position for women’s thoracolumbar fascia ultrasound (Persian)]. Journal of Isfahan Medical School. 2017; 35(433):671-6. [Link]
Yadollahpour A, Rashidi SA. Therapeutic applications of electromagnetic fields in musculoskeletal disorders: A review of current techniques and mechanisms of action. Biomedical and Pharmacology Journal. 2015; 7(1):23-32. [DOI:10.13005/bpj/448]
Omar AS, Awadalla MA, El-Latif MA. Evaluation of pulsed electromagnetic field therapy in the management of patients with discogenic lumbar radiculopathy. International Journal of Rheumatic Diseases. 2012; 15(5):e101-8. [DOI:10.1111/j.1756-185X.2012.01745.x] [PMID]
Taradaj J, Ozon M, Dymarek R, Bolach B, Walewicz K, Rosińczuk J. Impact of selected magnetic fields on the therapeutic effect in patients with lumbar discopathy: A prospective, randomized, single-blinded, and placebo-controlled clinical trial. Advances in Clinical and Experimental Medicine. 2018; 27(5):649-66. [DOI:10.17219/acem/68690] [PMID]
Ropper AH, Zafonte RD. Sciatica. The New England Journal of Medicine. 2015; 372(13):1240-8. [DOI:10.1056/NEJMra1410151] [PMID]
Poquet N, Lin CW. Management strategies for sciatica (PEDro synthesis). British Journal of Sports Medicine. 2016; 50(4):253-4. [DOI:10.1136/bjsports-2015-095268] [PMID]
Chou R, Hashimoto R, Friedly J. Epidural corticosteroid injections for radiculopathy and spinal stenosis. Annals of Internal Medicine. 2016; 164(9):635-6. [DOI:10.7326/L15-0567] [PMID]
Oliveira CB, Maher CG, Ferreira ML, Hancock MJ, Oliveira VC, McLachlan AJ, et al. Epidural corticosteroid injections for lumbosacral radicular pain. The Cochrane Database of Systematic Reviews. 2020; 4(4):CD013577. [DOI:10.1002/14651858.CD013577] [PMID] [PMCID]
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(5):449-68. [DOI:10.36076/ppj.2018.5.449] [PMID]
Knezevic NN, Jovanovic F, Voronov D, Candido KD. Do corticosteroids still have a place in the treatment of chronic pain? Frontiers in Pharmacology. 2018; 9:1229. [DOI:10.3389/fphar.2018.01229] [PMID] [PMCID]
Basso M, Cavagnaro L, Zanirato A, Divano S, Formica C, Formica M, et al. What is the clinical evidence on regenerative medicine in intervertebral disc degeneration? Musculoskeletal Surgery. 2017; 101(2):93-104. [DOI:10.1007/s12306-017-0462-3] [PMID]
Sanapati J, Manchikanti L, Atluri S, Jordan S. Do regenerative medicine therapies provide long-term relief in chronic low back pain: A systematic review and meta analysis. Pain Physician. 2018; 21(6):515-40. [DOI:10.36076/ppj.2018.6.515]
Costa T, Linhares D, Ribeiro da Silva M, Neves N. Ozone therapy for low back pain. A systematic review. Acta Reumatologica Portuguesa. 2018; 43(3):172-81. [PMID]
Migliorini F, Maffulli N, Eschweiler J, Bestch M, Tingart M, Baroncini A. Ozone injection therapy for intervertebral disc herniation. British Medical Bulletin. 2020; 136(1):88-106. [DOI:10.1093/bmb/ldaa032] [PMID]
Buric J, Rigobello L, Hooper D. Five and ten year follow-up on intradiscal ozone injection for disc herniation. International Journal of Spine Surgery. 2014; 8:17. [DOI:10.14444/1017] [PMID] [PMCID]
| Issue | Vol 18 No 2 (2024) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v18i2.15969 | |
| Keywords | ||
| Radiculopathy Low back pain Pain management | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
