Management of axial back pain: A critical view

摘要

The current issue of Techniques in Regional Anesthesia and Pain Management tackles a controversial topic: axial spine pain from intervertebral disc diseases (IDD) and its management. Although this issue does not address physio-therapeutic management or common surgical interventions for IDD, it focuses more on what pertains -to the discipline and practice of Pain Medicine. The first article describes potential pathophysiologic mechanisms of IDD. This is an important contribution because it will help us understand the potential mechanisms by which the interventional procedures, later discussed in this issue, may help patients affected with this problem. Two subsequent articles address discography and its role as a diagnostic modality both as a pretest for surgery and spine procedures. The rest of the articles describe the available minimally invasive thermal and decompressive disc techniques, focusing more on in-tradiscal electrotherapy (IDET) and nucleoplasty. Unfortunately, none of the articles give us a clear answer to the pathophysiologic mechanisms of axial discogenic back pain and the appropriate way to manage it. The level of evidence is weak and controversial at best. And while there are encouraging signs on perhaps one front (nucleoplasty), we are still in search of a unified prototype that encompasses a systematic approach of assessing, diagnosing, and treating axial discogenic back pain.