Chronic Discogenic Low Back Pain and Non-Surgical Treatment Methods: An Update

Özet

Low back pain originating from intervertebral disc is described by two separate but related etiologies: disc herniation and discogenic pain. When other causes are excluded, prevalence of discogenic pain was reported to be between 17-42%. Diagnostic modalities include clinical examination, imaging, and discography and provocative discography remains to be the golden standard for diagnosis. Treatment methods include noninvasive approaches such as drugs, physiotherapy modalities, and multidisciplinary biopsychosocial rehabilitation; invasive approaches such as intradiscal treatments and epidural injections; and lastly surgical approaches such as fusion and artificial joint replacement. Evidence for drug treatment in chronic discogenic low back pain is limited to nonsteroidal anti-inflammatory drugs and opioids which are associated with many adverse outcomes. It has been shown that when noninvasive methods are used together with other modalities patients may obtain additional benefits. Evidence base is limited for many other physical and behavioral treatment methods like low back school and specific exercise programs. There is moderate evidence for epidural injections and poor evidence for intradiscal treatments. Evidence for surgical fusions and disc replacements are similar and it is not superior to multidisciplinary biopsychosocial rehabilitation or well-designed physical treatment. Multiple authorities have emphasized potential complications and limited the indication of surgical approaches to patients who do not response conservative treatments. In future, the most promising treatments seem to be multidisciplinary and long-term exercise programs and/or epidural injections. High quality randomized controlled studies with adequate sample sizes and long term follow ups should be designed in order to determine optimal treatment modalities.Key words: discogenic low back pain, non-surgical treatment, updates

Abstract

Objective: In recent years, during routine examination of bone marrow aspirates, an increased plasma cell percentage has been noted in a good number of cases which included both neoplastic and non-neoplastic diseases. An attempt has been made to observe the spectra of conditions with plasmacytosis in bone marrow.Methods: The present study was conducted in the department of pathology over a period of one year. A total of 114 bone marrow aspirates that showed increased plasma cells (>3.5%) constitute the study material. A detailed relevant clinical examination followed by complete blood count, peripheral smear examination and bone marrow aspiration was done in all cases.Results: There was slight female predominance with male to female ratio of 1:1.1. The majority of patients were in 4th decade. The plasma cell concentration ranged from 5% to 36%. As far as the etiology is concerned, 96 cases (84.2%) were non-neoplastic and 18 cases (15.7%) had neoplastic etiology.Conclusion: Bone marrow plasmacytosis can present as diagnostic dilemma and some time can be challenging to differentiate reactive from neoplastic condition as there is an overlap both in counts and morphology. Each case with plasmacytosis especially in the overlap range requires complete clinical evaluation, individualized investigations and more specific tests like immunoelectrophoresis and bone marrow biopsy with immunohistochemistry to arrive at a final diagnosis for patient management.Key words: Reactive plasmacytosis, bone marrow, multiple myeloma, megaloblastic anaemia

Anahtar kelimeler: diskojenik bel ağrısı, cerrahi dışı tedavi, güncelleme