The Invasive Management of Pain: Diagnosis and New Treatment Options

Cureus, 2023 · DOI: 10.7759/cureus.42717 · Published: July 31, 2023

Simple Explanation

The diagnosis and treatment of pain, especially through interventional methods, are constantly evolving, particularly with an expanded role for ultrasound in diagnosing low back pain. Regenerative medicine, such as platelet-rich plasma, is showing promise in treating musculoskeletal pain by stimulating the body’s own regenerative responses and is safe due to the use of autologous blood products. Neuromodulation, especially spinal cord stimulation, is being revitalized with new technologies and a better understanding of how it works, making it a safe and cost-effective option for appropriately selected patients with specific back problems.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Level 5, Narrative Review

Key Findings

1
Autologous blood products like platelet-rich plasma are safe and effective in stimulating the body’s regenerative responses for musculoskeletal pain.
2
Spinal cord stimulation, while not a first-line therapy, can be a safe, effective, and cost-effective treatment for specific back problems with proper patient selection.
3
Radiofrequency ablation of nerves, including newer cooled techniques, can effectively reduce pain from osteoarthritis, restore function, and potentially reduce opioid use, requiring expertise in nerve anatomy.

Research Summary

Diagnosis of low back pain combines old and new methodologies, in particular, it involves an expanded role for ultrasound. Tumors and infections are rarely involved in low back pain but should be ruled out in the initial phase itself since failing to address them early can have devastating consequences. Treating musculoskeletal pain with regenerative medicine, such as platelet-rich plasma, holds great promise. Autologous blood products are safe and may help stimulate the body’s own responses for regeneration. Neuromodulation, especially spinal cord stimulation, is undergoing a renaissance with new waveforms, devices, and a greater albeit incomplete understanding of its mechanisms of action. Spinal cord stimulation is not a first-line therapy and not all patients or all back problems respond to this treatment.

Practical Implications

Enhanced Diagnostic Precision

Increased use of ultrasound in diagnosing low back pain allows for more precise and detailed assessments of the condition.

Novel Therapeutic Options

Regenerative medicine and radiofrequency neurotomy provide new avenues for treating pain associated with osteoarthritis and other conditions, offering alternatives to traditional methods.

Personalized Pain Management

Matching appropriate patients with suitable treatments, including multi-mechanistic approaches, ensures more effective and tailored pain relief.

Study Limitations

1
Many of the procedures described in this review are novel and have not undergone extensive literary review or been the subject of randomized clinical trials.
2
Evidence remains equivocal as to whether surgical treatment is superior to conservative management for lumbar spinal stenosis.
3
The mechanisms of action of spinal cord stimulation remain incompletely elucidated

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