Yoga for chronic low back pain: a randomized trial. Tilbrook HE, Cox H, Hewitt CE, et al. Ann Intern Med 2011;155(9):569–78.

ABSTRACT Introduction Low back pain behaves as a “silent epidemic,” ranking first among complications related to work. Often there is a large gap between a patient's desired pain reduction and the minimum percentage of improvement that would make a treatment worthwhile. Consequently, debate continues as to the value of epidural steroid injections, supremacy of one adjuvant over others, various doses, and concentrations in optimizing pain management. Objective To compare the efficacy of ketamine vs normal saline as an adjuvant to epidural steroids in chronic low back pain. Study design Randomized prospective placebo-controlled study. Materials and methods The study was conducted on 60 patients of age group 18 to 70 years having chronic lower backache with or without radiculitis of minimum 3 months duration and having no relief with conventional treatment. The patients selected were randomly allocated into two groups of 30 patients each: Group I (n = 30) given triamcinolone 40 mg, preservative-free ketamine 30 mg (0.6 mL) made up to 6 mL solution with 0.25% bupivacaine and group II (n = 30) given 0.6 mL normal saline instead of ketamine. Outcome measures The primary outcome measured was number of patients requiring repeat blocks and number of repeat blocks administered in 3 months. Other outcome measures were functional improvement quantified by visual analog scale (VAS) and Oswestry disability index (ODI) as well as improvement in psychological status by depression scoring, all taken at 2 weeks interval for 3 months. The periprocedural complications were also noted at the end of the study. Results In managing lumbar radicular pain with lumbar epidural steroid injection (LESI), ketamine's role as an adjuvant proved to be advantageous for long-term relief by its inhibition of dorsal horn “wind up” phenomenon through N-methyl-D-aspartate (NMDA) receptor antagonism, thus reducing frequency of repeat blocks in group II (ketamine). Conclusion Thus to conclude, ketamine's advantage as a drug that prolongs pain relief from LESI is an avenue for further research and promises a bright future in the field of interventional pain medicine. How to cite this article Gupta R, Bawa C, Singh S, Mahajan L, Kaur B, Kaur T. Prospective Placebo-controlled Randomized Trial to compare the Efficacy of Ketamine as an Adjuvant to Epidural Steroids in preventing Repeat Blocks in Chronic Low Back Pain. Curr Trends Diagn Treat 2017;1(1):15-21.

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Comparing lumbosacral orthosis to routine physical therapy on postural stability in patients with chronic low back pain: A randomized trial

Medical Journal of the Islamic Republic of Iran ◽

10.18869/mjiri.31.26 ◽

2017 ◽

Vol 31 (1) ◽

pp. 150-157 ◽

Cited By ~ 2

Author(s):

Fatemeh Azadinia ◽

Ismail Ebrahimi-Takamjani ◽

Mojtaba Kamyab ◽

Mohamad Parnianpour ◽

Morteza Asgari ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Randomized Trial ◽

Chronic Low Back Pain ◽

Postural Stability ◽

Low Back

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A Randomized Trial of Combined Manipulation, Stabilizing Exercises, and Physician Consultation Compared to Physician Consultation Alone for Chronic Low Back Pain

Spine ◽

10.1097/01.brs.0000085096.62603.61 ◽

2003 ◽

Vol 28 (19) ◽

pp. 2185-2191 ◽

Cited By ~ 147

Author(s):

Leena Niemistö ◽

Tiina Lahtinen-Suopanki ◽

Pekka Rissanen ◽

Karl-August Lindgren ◽

Seppo Sarna ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Randomized Trial ◽

Chronic Low Back Pain ◽

Low Back ◽

Physician Consultation

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Clinical Pilates versus general exercise for chronic low back pain: randomized trial. Wajswelner H, Metcalf B, Bennell K. Med Sci Sports Exerc 2012;44(7):1197-205

The Spine Journal ◽

10.1016/j.spinee.2013.03.037 ◽

2013 ◽

Vol 13 (5) ◽

pp. 592

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Randomized Trial ◽

Chronic Low Back Pain ◽

Low Back ◽

General Exercise

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Pragmatic Randomized Trial Evaluating the Clinical and Economic Effectiveness of Acupuncture for Chronic Low Back Pain

American Journal of Epidemiology ◽

10.1093/aje/kwj224 ◽

2006 ◽

Vol 164 (5) ◽

pp. 487-496 ◽

Cited By ~ 184

Author(s):

Claudia M. Witt ◽

Susanne Jena ◽

Dagmar Selim ◽

Benno Brinkhaus ◽

Thomas Reinhold ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Randomized Trial ◽

Chronic Low Back Pain ◽

Economic Effectiveness ◽

Low Back

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The Effect of Cognitive Load and Patient Race on Physicians' Decisions to Prescribe Opioids for Chronic Low Back Pain: A Randomized Trial: Table 1

Pain Medicine ◽

10.1111/pme.12378 ◽

2014 ◽

Vol 15 (6) ◽

pp. 965-974 ◽

Cited By ~ 24

Author(s):

Diana J. Burgess ◽

Sean Phelan ◽

Michael Workman ◽

Emily Hagel ◽

David B. Nelson ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Cognitive Load ◽

Randomized Trial ◽

Chronic Low Back Pain ◽

Low Back ◽

Patient Race

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Prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 12-month results

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-102259 ◽

2021 ◽

pp. rapm-2020-102259

Author(s):

Matthew Smuck ◽

Jad Khalil ◽

Kevin Barrette ◽

Joshua Adam Hirsch ◽

Scott Kreiner ◽

...

Keyword(s):

Quality Of Life ◽

Low Back Pain ◽

Back Pain ◽

Randomized Trial ◽

Primary Endpoint ◽

Chronic Low Back Pain ◽

Short Form ◽

Low Back ◽

Opioid Use

IntroductionVertebral endplates, innervated by the basivertebral nerve (BVN), are a source of chronic low back pain correlated with Modic changes. A randomized trial comparing BVN ablation to standard care (SC) recently reported results of an interim analysis. Here, we report the results of the full randomized trial, including the 3-month and 6-month between-arm comparisons, 12-month treatment arm results, and 6-month outcomes of BVN ablation in the former SC arm.MethodsProspective, open label, 1:1 randomized controlled trial of BVN ablation versus SC in 23 US sites with follow-up at 6 weeks, 3, 6, 9, and 12 months. SC patients were re-baselined and followed up for 6 months post BVN ablation. The primary endpoint was the between-arm comparison of mean Oswestry Disability Index (ODI) change from baseline. Secondary endpoints were Visual Analog Scale (VAS), Short Form (SF-36), EuroQual Group 5 Dimension 5-Level Quality of Life (EQ-5D-5L), responder rates, and rates of continued opioid use.Results140 were randomized. Results from BVN ablation (n=66) were superior to SC (n=74) at 3 months for the primary endpoint (mean ODI reduction, difference between arms of −20.3 (CI −25.9 to −14.7 points; p<0.001)), VAS pain improvement (difference of −2.5 cm between arms (CI −3.37 to −1.64, p<0.001)) and quality of life outcomes. At 12 months, basivertebral ablation demonstrated a 25.7±18.5 point reduction in mean ODI (p<0.001), and a 3.8±2.7 cm VAS reduction (p<0.001) from baseline, with 64% demonstrating ≥50% reduction and 29% pain free. Similarly, the former SC patients who elected BVN ablation (92%) demonstrated a 25.9±15.5 point mean ODI reduction (p<0.001) from baseline. The proportion of opioid use did not change in either group (p=0.56).Discussion/ConclusionBVN ablation demonstrates significant improvements in pain and function over SC, with treatment results sustained through 12 months in patients with chronic low back pain of vertebrogenic origin.

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