The spine journal : official journal of the North American Spine Society
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Pain innate to intervertebral disc, often referred to as discogenic pain, is suspected by some authors to be the major source of chronic low back and neck pain. Current management of suspected discogenic pain lacks standardized diagnosis, treatment, and terminology. ⋯ Our findings show that suspected discogenic pain, despite its extensive affirmation in the literature and enormous resources regularly devoted to it, currently lacks clear diagnostic criteria and uniform treatment or terminology.
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After decades of clinical research, the role of surgery for chronic nonspecific low back pain (CNLBP) remains equivocal. Despite significant intellectual, human, and economic investments into randomized controlled trials (RCTs) in the past two decades, the role of surgery in the treatment for CNLBP has not been clarified. ⋯ The research agenda of RCTs for surgery of CNLBP has not changed substantially in the last 20 years. Technical trials evaluating nuances of surgical techniques significantly predominate. Despite the publication of four RCTs reporting equivocal benefits of surgery for CNLBP between 2001 and 2006, there was no change in the research agenda of subsequent RCTs, and technical trials continued to outnumber indication trials. Rather than clarifying what, if any, indications for surgery exist, investigators in the field continue to analyze variations in surgical technique, which will probably have relatively little impact on patient outcomes. As a result, clinicians unfortunately have little evidence to advise patients regarding surgical intervention for CNLBP.
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Accurate measurement of functional improvement in clinical practice is becoming increasingly recognized as essential in demonstrating whether patients are deriving meaningful benefit from care. Several simple questionnaires have been developed for this purpose. The majority of these have been developed in English. In North America, there is a growing need for clinical tools, including outcome assessment tools that are available in the Spanish language. ⋯ Several reliable and valid outcome assessment questionnaires are available in the Spanish language. All were originally developed in English. It appears from the data reviewed that the most useful instruments are the NDI for neck pain patients and the ODI and RMQ for low back pain patients. The current trend is for the development of culturally adapted versions of these questionnaires that are specific to a particular country or region.