Title : Combining radial extracorporeal shock wave therapy and local corticosteroid injection in patient wth chronic non specific neck And low back pain: Is It improving the quality of life?
Abstract:
Chronic pain is defined as pain that persists beyond three to six months after tissue injury. The prevalence of chronic pain has been reported in many studies. It is a multidimensional problems that can affect physical and psychological aspects of the afflicted individual’s life, work and daily activities. Neck and low back pain are musculoskeletal conditions that often becomes chronic and can result in high level of disabilities. The Global burden of disease study identified neck pain as the fourth highest condition on number of years lived with disability. Low back pain as well, is the second leading cause of disability among adults of all ages worldwide, nearly 15% of the patients with low back pain may be presentably disabled. The etiology of mechanical neck pain is under debate, and it seems to be multifactorial. Thus, some cases of chronic neck pain considered non specific. At the same time, many patients with low back pain cannot be specifically diagnosed and approximately 85% of cases cannot be attributed to specific pathological changes or nerve root irritation; therefore, most patient with low back pain have non specific low back pain. The primary goal in chronic pain treatment is to improve the patient’s level of function and the capacity for return to work, while decreasing as much as possible the frequency and intensity of pain while simultaneously reducing medication consumption. The multimodal regimen is superior to unimodal pain treatments in terms of pain reduction, improved physical fuctioning and returning patients to workforce. This descriptive qualitative study initially will review the patients latest condition after underwent three months of radial extracorporeal shock wave therapy (rESWT) and local corticosteroid injection combined. Fifty patients referred from neurology department are enrolled in this study. Patients must have experienced of unexplained neck and back pain for three to six months, adults over the age of 18 and have underwent twice weekly of rESWT using 1500 pulses/session with energy level of 2-4; 10-16 Hz, for 7 minutes and once local corticosteroid injection using 1 ml of lidocaine and 2 ml of dexamethasone. We use SF-36 questionnaire, modified ODI score and numerical rating scale (NRS) to evaluate the patients disabilities. The outcome had to be pain and or disability. Based on the questions answered, results have demonstrated improvement in patients daily activities, returning to work and also reducing pain recurrences. This study shows that steroid injection alone doesn’t provide a long term pain free effect but combined with radial extracorporeal shock wave therapy make the patients pain free for longer time. This multimodal regimens approach are helping them with chronic non specific neck and back pain achieving their best quality of life. Nevertheless, further studies are needed to evaluate the efficacy of this combination therapy or other multimodalites treatment for chronic pain. The development of refined clinical strategies to predict positive outcomes and to optimize individualized combination therapy is the goal for future improvements.
