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J Pain. 2016 May;17(5):569-76. doi: 10.1016/j.jpain.2016.01.469. Epub 2016 Jan 30.

Paraspinous Lidocaine Injection for Chronic Nonspecific Low Back Pain: A Randomized Controlled Clinical Trial.

Author information

1
Physical and Rehabilitation Medicine Division, Orthopedics and Traumatology Institute, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil; Clinical Research Center, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
2
Center for Pain, Orthopedics and Traumatology Institute, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
3
Clinical Research Center, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
4
Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Placebo Studies Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
5
Physical and Rehabilitation Medicine Institute (IMREA), Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
6
Spine Group, Orthopedics and Traumatology Institute, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
7
Musculoskeletal System Medical Research Laboratory-LIM 41, Orthopedics and Traumatology Institute, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
8
Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: felipe.fregni@mgh.harvard.edu.

Abstract

In this large, sham-controlled, randomized trial, we examined the efficacy of the combination of standard treatment and paraspinous lidocaine injection compared with standard therapy alone in subjects with chronic low back pain. There is little research-based evidence for the routine clinical use of paraspinous lidocaine injection for low back pain. A total of 378 subjects with nonspecific chronic low back pain were randomized to 3 groups: paraspinous lidocaine injection, analgesics, and exercises (group 1, LID-INJ); sham paraspinous lidocaine injection, analgesics, and exercises (group 2, SH-INJ); and analgesics and exercises (group 3, STD-TTR). A blinded rater assessed the study outcomes at 3 time points: baseline, after treatment, and after 3 months of follow-up. There were increased frequency of pain responses and better low back functional scores in the LID-INJ group compared with the SH-INJ and STD-TTR groups. These effects remained at the 3-month follow-up but differed between all 3 groups. There were significant changes in pain threshold immediately after treatment, supporting the effects of this intervention in reducing central sensitization. Paraspinous lidocaine injection therapy is not associated with a higher risk of adverse effects compared with conventional treatment and sham injection. Its effects on hyperalgesia might correlate with changes in central sensitization.

CLINICAL TRIAL REGISTRATION:

NCT02387567.

PERSPECTIVE:

There are few data to support paraspinous lidocaine injection use in patients with nonspecific chronic low back pain. Our results show that this therapy when combined with standard therapy significantly increases the number of responders versus standard treatment alone. Its effects on hyperalgesia might correlate with a change in central sensitization.

KEYWORDS:

Randomized clinical trial; central sensitization; evidence-based medicine; nonspecific chronic low back pain; paraspinous lidocaine injection

PMID:
26828801
PMCID:
PMC4910884
DOI:
10.1016/j.jpain.2016.01.469
[Indexed for MEDLINE]
Free PMC Article

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