title: A preliminary study to determine if a muscle pain protocol can produce long-term relief in chronic back pain patients.
abstract: OBJECTIVE
  To assess the effectiveness of a muscle protocol to treat patients diagnosed with neuraxial low back pain (LBP) before and after invasive treatments.
  
  
  METHODS
  Patients with chronic (>6 months) LBP-postinvasive treatment and pre-spine surgery-were assessed and treated. An electrical device rather than palpation was used to determine muscle(s) as possible sources of pain. Patients testing positive for muscle pain were treated with a comprehensive protocol and were followed for >3 months to determine the effect of treatment on pain severity and interference in function.
  
  
  RESULTS
  Study 1: In 56 (postinvasive treatment) patients who had failed back surgery, epidural steroid injections, facet blocks, and/or trigger point injections, mean Brief Pain Inventory (BPI) pain severity dropped from 5.54 at baseline to 3.96 (P < 0.001) at a median follow-up of 77 weeks; mean BPI interference dropped from 6.09 to 3.4 (P < 0.001). Fifty-two percent of respondents reported over 50% relief. Study 2: Three of seven patients originally scheduled for spine surgery completed a substantial part of the muscle protocol, canceled their surgeries, and obtained significant relief at the 16-19 month follow-up point.
  
  
  CONCLUSIONS
  In patients thought to have neuraxial pain, identification and treatment of painful muscles had statistically significant long-lasting and clinically meaningful reductions in pain and improvement in function. Muscle and tendon attachments may be an important and treatable source of pain in patients diagnosed with pre and postsurgical neuraxial pain.
authors.affiliation: Department of Anesthesiology, NYU Langone Medical Center, Norman Marcus Pain Institute, New York, New York 10016, USA. njm@nmpi.com
authors.forename: Norman J
authors.initials: NJ
authors.lastname: Marcus
authors.forename: Allyson Augusta
authors.initials: AA
authors.lastname: Shrikhande
authors.forename: Bill
authors.initials: B
authors.lastname: McCarberg
authors.forename: Edward
authors.initials: E
authors.lastname: Gracely
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D004558:Electric Stimulation; D004599:Electric Stimulation Therapy; D004568:Electrodiagnosis; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008134:Long-Term Care; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000503:physiopathology; D059352:Musculoskeletal Pain / Q000188:drug therapy / Q000628:therapy*; D010147:Pain Measurement; D018579:Patient Selection; D026741:Physical Therapy Modalities; D018583:Pliability; D012189:Retrospective Studies; D013710:Tendons; D017211:Treatment Failure; D055815:Young Adult
keywords: Failed Back Surgery Syndrome; Low Back Pain; Muscle Pain; Sciatica; Spine Surgery