THU0487 PERINEURAL INJECTION THERAPY; A NEW MODALITY IN MANAGEMENT OF MECHANICAL LOW BACK PAIN; A COMPARATIVE STUDY
Authors: Mohammed Hassan Abu-Zaid, Samar Abd Alhamed Tabra
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Chronic mechanical low back pain represents the second leading cause of disability worldwide being a major welfare and economic problem<sup>1</sup>. Subcutaneous prolotherapy treats prolonged pathological peripheral neurogenic inflammation for several painful conditions. As it induces apoptosis of proliferating peptidergic noceffectors and neovessels by reducing vascular endothelial growth factor <sup>2</sup> <h3>Objectives</h3> To assess the effectiveness of subcutaneous perineural injection therapy in management of pain, physical function, disability and psychological status in mechanical low back pain <h3>Methods</h3> Ninety patients with non-radiating non-specific chronic mechanical low back pain (LBP) that persisted for 12 weeks or more were selected in this study. (Patients with inflammatory LBP, radiating, or LBP due to specific cause, pregnant women or Patients with implanted pacemaker or spinal cord stimulator were excluded from this study). After giving written consent; the patients were randomly divided into 3 groups 30 patients in each. Group I recieved 8 weekly subcutaneous injections of 1 ml of buffered dextrose 5% in each chronic constriction injury points and tender points in back and buttock. Group II treated by using pulsed electromagnetic field stimulation (PEMFs) for 30 minutes over the lower lumbar region with frequency of 10 Hz and intensity of 2 millitesla every other day for 8 weeks. Group III received sham PEMFs. All patients will be instructed to follow an exercise program in the form of stretching for hamstring, calf, and back muscles, and strengthening exercises for back and abdominal muscles. Assessments were performed at baseline, at the end of the treatment and after four months, using the following measurements: visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Lequesne index, Hospital Anxiety and Depression Scale (HADS). <h3>Results</h3> The mean age of patients in the 3 groups was 40.2±10.5, 38.3±9.9, and 43.1±10.8 respectively. The mean VAS was 7.9+1.4, 8.2+0.6, and 7.6+1.1 respectively. No baseline differences existed between all groups in all parameters. There was significant improvement in VAS, WOMAC and HDAS in group I &amp; II (p&lt;0.05) after treatment, and 4 months later (figure 1). While the improvement in group III was non-significant (p&gt;0.05). The improvement in group I was better than in group II with significant difference between the two groups (p&lt;0.05) after treatment and 4 months follow up. <h3>Conclusion</h3> Perineural Injection Therapy is an effective new modality in management of pain, physical function, psychological status and disability in mechanical low back pain. <h3>References</h3> [1] Massimo Allegri, Silvana Montella, Fabiana Salici et al., Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research 2016, 5(F1000 Faculty Rev):1530 Last updated: 11 OCT 2016 doi: [10.12688/f1000research.8105.2] [2] Lyftogt, J. Prolotherapy for Recalcitrant Lumbago. Australasian Musculoskeletal Medicine, 2008; 13(1): 18-20. <h3>Disclosure of Interests</h3> None declared