Discogenic Pain and Thermal Annular Procedures
Fnu Kailash, M.D.
Fellow Physician
Salim M Hayek, M.D., Ph.D.
Associate Professor
Chief, Division of Pain Medicine
Joshua Goldner, M.D.
Assistant Professor
Department of Anesthesiology
Case Western Reserve University
University Hospitals Case Medical Center
11100 Euclid Ave
Cleveland, OH 44106
Copyright ©2010 Covidien. All rights reserved. Reprinted with the permission of the Energy Based Devices Division of Covidien
Introduction
The lifetime prevalence of low back pain (LBP) has been reported as between 54% and 80%.1 LBP is one of the most common reasons for visits to internists and the second most common reason for disability in the United States.2,3 The prevalence of chronic low back pain ranges from 15-45%, with a median point prevalence of 30%.1 It is the most significant source of spine-related pain and is associated with significant economic, societal and health implications. The impact of low back pain on the US economy can be gauged from the fact that spine-related health care expenditure reached around $86 billion for the year 2005, increasing 65% since 1997.4 The increase in health care utilization among those with LBP is multifactorial, including an increased prevalence of acute and chronic LBP, increased prevalence of those with chronic LBP who seek care, increased per-user health care cost, and innovation in interventional techniques.4-6
The true burden of low back pain – both personally and economically – comes not from those who suffer from acute low back pain, but those who deal with its chronic variant. It has long been thought that 80-90% of acute episodes of low back pain will resolve in about six weeks with 5-10% of cases progressing to persistent pain.7 More recent studies show evidence to the contrary. That is, a significant minority (as many as two third) of patients will experience relapses and recurrent episodes of long lasting pain. In a 2008 study, Stanton et al. reported recurrence rates of low back pain as high as 24% to 33%.8
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