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Chronic low back pain (cLBP) is the most frequently reported cause of years lived with disability. Identifying the anatomical structures or dysfunction contributing to patients\' symptoms is critical to guiding treatment. The etiology of back pain and differential diagnosis is often broad, ranging from non-degenerative cLBP (trauma, tumor, inflammation, infection, etc.) to degenerative (also described as nonspecific) cLBP. After eliminating suspicion for more insidious causes of cLBP, a thorough investigation can be conducted in an attempt to identify a source of degenerative cLBP. Degenerative cLBP can originate from many sources, and a detailed understanding of the structures potentially involved is invaluable for an accurate diagnosis. This review article aims to provide a broad overview of the utility of clinical history, physical exam findings, imaging findings, and diagnostic procedures in identifying the cause of patients\' cLBP. We provide a framework to help guide clinicians by dividing the structures into groups as follows: anterior vertebral column, posterior vertebral column, and extra-vertebral pain. For each condition listed, we touch on the treatment options that can be considered.

Proinflammatory cytokines play a critical role in chronic inflammation and pain and contribute to behavioral symptoms (depressive symptoms, anxiety, fatigue, sleep disturbance) and comorbidities (diabetes, cardiac diseases, cancer). Evidence is lacking on the specific proinflammatory cytokines associated with these behavioral symptoms/comorbidities co-occurring with axial low back pain (aLBP). This review aimed to systematically analyze the following: (1) specific proinflammatory cytokines associated with aLBP in adults, (2) associations among proinflammatory cytokines and behavioral symptoms in aLBP, and (3) relationships among proinflammatory cytokines and comorbidities in aLBP, to develop a new clinical framework for future diagnostic and intervention targets for patients with aLBP.
Electronic databases, including PubMed/MEDLINE, ProQuest Nursing & Allied Health Source, and CINAHL Complete (EBSCO) were searched for the period January 2012 to February 2023. Eligible studies included cross-sectional, case-control, longitudinal, and cohort studies in which proinflammatory cytokines were reported in adults above 18 years with aLBP. Intervention studies and randomized controlled trails were excluded. The Joanna Briggs Institute (JBI) criteria were used for quality evaluation.
Findings from 11 studies showed 3 proinflammatory cytokines associated with pain intensity in adult patients with aLBP: C-Reactive Protein (CRP), Tumor Necrosis Factor (TNF-α), and Interleukin (IL-6). Some studies assessed associations between proinflammatory cytokines and depressive symptoms; none explored the association of proinflammatory cytokines with fatigue, anxiety, sleep disturbance, or comorbidities (diabetes, cardiac diseases, and cancer) in aLBP.
Proinflammatory cytokines in aLBP can serve as composite biomarkers for pain, associated symptoms, and comorbidities and may serve as a target for future interventions. There is need for well-designed studies assessing associations among chronic inflammation, behavioral symptoms, and comorbidities.

Intraosseous basivertebral nerve ablation has shown sustained efficacy in treating chronic axial low back pain (LBP) in patients with type 1 or 2 Modic changes. This systematic review aims to determine the efficacy of intraosseous basivertebral nerve radiofrequency ablation in treating nonradiating axial chronic LBP compared to standard therapy, sham, or without contrast. The population of interest is individuals greater than or equal to 18 years old with chronic nonradiating vertebrogenic pain. The key outcome was the percentage of patients with greater than or equal to 50% pain reduction, greater than or equal to 10-point improvement in function and disability measured by the Oswestry Disability Index (ODI), greater than or equal to two-point pain reduction in the visual analog scale (VAS) or numerical pain rating scale, and a decrease in opioid utilization by 10 morphine milligram equivalents. Three databases, PubMed, MEDLINE, and Google Scholar, were used to retrieve the studies for the review. Two independent reviewers assessed the studies for inclusion using the validated tools for quality appraisal. There were 286 articles in total; however, only 11 publications with extensive data on 413 participants matched the inclusion criteria and were used for this review. At three months, a majority of the participants reported greater than or equal to 10-point improvement in the ODI, a measure of functional and disability improvement on a 10-point scale, and greater than or equal to two-point improvement in the VAS. A good number of patients in the basivertebral nerve ablation (BVNA) arm reported complete pain resolution demonstrating therapy success and the superiority of BVNA over sham and standard treatment.  Basivertebral nerve radiofrequency ablation, among other criteria, is a safe and minimally invasive therapy that significantly lowers pain and impairment in individuals with vertebrogenic pain with distinct Modic type 1 and 2 changes at lumbar vertebra three-sacral vertebra one (L3-S1) vertebral levels. Proper patient selection and exact procedural methods are essential to the success of basivertebral nerve neurotomy. The findings of the existing investigations require confirmation by nonindustry-funded, large-scale, high-quality trials using generalizable study participants.

BACKGROUND: The objective of this prospective, multicenter study is to characterize responses to percutaneous medial branch peripheral nerve stimulation (PNS) to determine if results from earlier, smaller single-center studies and reports were generalizable when performed at a larger number and wider variety of centers in patients recalcitrant to nonsurgical treatments.
METHODS: Participants with chronic axial low back pain (LBP) were implanted with percutaneous PNS leads targeting the lumbar medial branch nerves for up to 60 days, after which the leads were removed. Participants were followed long-term for 12 months after the 2-month PNS treatment. Data collection is complete for visits through end of treatment with PNS (primary end point) and 6 months after lead removal (8 months after start of treatment), with some participant follow-up visits thereafter in progress.
RESULTS: Clinically and statistically significant reductions in pain intensity, disability, and pain interference were reported by a majority of participants. Seventy-three percent of participants were successes for the primary end point, reporting clinically significant (≥30%) reductions in back pain intensity after the 2-month percutaneous PNS treatment (n = 54/74). Whereas prospective follow-up is ongoing, among those who had already completed the long-term follow-up visits (n = 51), reductions in pain intensity, disability, and pain interference were sustained in a majority of participants through 14 months after the start of treatment.
CONCLUSIONS: Given the minimally invasive, nondestructive nature of percutaneous PNS and the significant benefits experienced by participants who were recalcitrant to nonsurgical treatments, percutaneous PNS may provide a promising first-line neurostimulation treatment option for patients with chronic axial back pain.

Aim: To evaluate pain and length of stay outcomes in six patients who received an erector spinae plane block (ESPB) in the emergency department (ED) for low back pain. Materials & methods: A case series of six patients who received unilateral or bilateral ESPB after presenting to the ED for acute atraumatic axial low back pain. Results: The average visual analog scale pain score reduction was 81.8%, and length of stay after ESPB was 73.5 min. No postprocedure opiates in the ED or after discharge were required. Conclusion: The ESPB is a rapid, safe and opiate-sparing option for the treatment of acute low back pain.
Lay abstract Acute low back pain is one of the most common reasons patients present to the emergency department (ED), and it is often difficult to treat. The erector spinae plane block (ESPB) is a nerve block used to treat thoracic, rib, spine and abdominal wall pain. There is currently limited evidence to support its use in treating low back pain in the ED. This case series looks at outcomes of six patients who presented to the ED with low back pain who were treated with an ESPB that targets the low back muscles. Visual Analog Scale pain score reduction after the procedure ranged between 71 and 100%, with an average of 81.8%. The average length of stay (LOS) prior to the nerve block was 225 min, with a range of 107–480 min. Average LOS after the block was 73.5 min, with a range of 26–180 min. Five of six patients did not have any return ED visits for back pain. All six patients required no opiates after the procedure in the ED or after discharge. These cases show the ESPB is a promising technique that gives emergency physicians a rapid, safe and opiate-sparing option for the treatment of low back pain. ESPBs can result in decreased pain, decreased LOS, decreased opiate requirements and decreased admission for refractory pain.

This prospective, open-label, multicenter study evaluated the feasibility of spinal cord stimulation (SCS) therapy programming for chronic low back pain that uses multiple electrical pulsed signals (Differential Target Multiplexed).
Twenty-five SCS candidates with low back pain equal to or greater than lower limb pain were enrolled at 7 sites in the United States. The subjects evaluated standard and Differential Target Multiplexed programs, each for 4 ± 1 days. A commercially available SCS trial system was used for standard SCS therapy programming. During the trialing of the multiplexed programs, implanted temporary leads were connected to an investigational external trial stimulator system.
Twenty subjects concluded the study. The mean baseline numeric pain rating scale (NPRS) score for low back pain was 7.4, with a mean age of 62.4 years and mean pain duration of 18.0 years. Significant relief in back pain was observed for both treatments, with significantly better response with multiplexed programming. At the end of the trial period, subjects reported a reduction in their mean NPRS score from baseline to 4.2 after standard programming and to 2.4 after Differential Target Multiplexed programming. The difference between standard and multiplexed programming was significant. The responder rate for low back pain relief was 50% for standard programming and 80% for Differential Target Multiplexed programming. Eighty-five percent of subjects who evaluated both programming approaches preferred Differential Target Multiplexed SCS.
In this difficult-to-treat patient population, subjects reported significant reduction in chronic back pain when using multiplexed programming. A randomized clinical trial is needed to confirm the results from this feasibility study.

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OBJECTIVE: Low back pain encompasses three distinct sources: axial lumbosacral, radicular, and referred pain. Annually, the prevalence of low back pain in the general US adult population is 10-30%, and the lifetime prevalence of US adults is as high as 65-80%.
RESULTS: Patient history, physical exam, and diagnostic testing are important components to accurate diagnosis and identification of patient pathophysiology. Etiologies of low back pain include myofascial pain, facet joint pain, sacroiliac joint pain, discogenic pain, spinal stenosis, and failed back surgery. In chronic back pain patients, a multidisciplinary, logical approach to treatment is most effective and can include multimodal medical, psychological, physical, and interventional approaches. Low back pain is a difficult condition to effectively treat and continues to affect millions of Americans every year. In the current investigation, we present a comprehensive review of low back pain and discuss associated pathophysiology, diagnosis, and treatment.

BACKGROUND: The injection of mixture of plain bupivacaine and triamcinolone acetonide into the sacroiliac joint (SIJ) to relieve chronic low back pain is uncommon in the West African sub-region. The objective of this study was to demonstrate the efficacy or otherwise of fluoroscopic-guided SI joint injection in the management of chronic axial low back pain in Nigeria.
METHODS: This was a prospective observational interventional study.
METHODS: The study was carried out at a tertiary hospital in Nigeria.
METHODS: Twenty-six patients with SI joint pain, based on IASP diagnostic criteria, who presented to our unit over 36 months from March 2012 to March 2015 and.
METHODS: Fluoroscopic-guided injections of 5mls mixture of bupivacaine and triamcinolone acetonide into the sacro-iliac (SI) joints of 26 patients with SI joint pain out of 116 patients who were offered different interventions for chronic low back pain. The patients were followed up for year and pain intensity and functional status were assessed at 3-, 6- and 12 months post-intervention.
METHODS: Pain relief and functional improvement were the main outcome measures.
RESULTS: The mean numeric rating score (NRS) and Oswestry Disability index (ODI) score in 14 (53.9%) patients at 12 months post-interventions were significantly lower compared with baseline values; 3.19 ± 1.10 vs 8.54 ±1.14 p=0.000 and 25.35 ± 5.40 vs 37.54 ±8.41, p=0.000 respectively.
CONCLUSIONS: Fluoroscopic-guided steroid injection into the SI joint resulted into reduction in pain intensity and improved physical function in the majority of patients with SI joint pain.
BACKGROUND: Not declared.