title: Paraspinous Lidocaine Injection for Chronic Nonspecific Low Back Pain: A Randomized Controlled Clinical Trial.
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.
  
  
  
  NCT02387567.
  
  
  
  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.
authors.affiliation: 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.
authors.forename: Marta
authors.initials: M
authors.lastname: Imamura
authors.affiliation: Center for Pain, Orthopedics and Traumatology Institute, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Satiko Tomikawa
authors.initials: ST
authors.lastname: Imamura
authors.affiliation: Clinical Research Center, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Rosa Alves
authors.initials: RA
authors.lastname: Targino
authors.affiliation: Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Placebo Studies Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: León
authors.initials: L
authors.lastname: Morales-Quezada
authors.affiliation: Physical and Rehabilitation Medicine Institute (IMREA), Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Luis C
authors.initials: LC
authors.lastname: Onoda Tomikawa
authors.affiliation: Clinical Research Center, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Luis G
authors.initials: LG
authors.lastname: Onoda Tomikawa
authors.affiliation: Clinical Research Center, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Fabio M
authors.initials: FM
authors.lastname: Alfieri
authors.affiliation: Clinical Research Center, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Thais R
authors.initials: TR
authors.lastname: Filippo
authors.affiliation: Spine Group, Orthopedics and Traumatology Institute, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Ivan D
authors.initials: ID
authors.lastname: da Rocha
authors.affiliation: Musculoskeletal System Medical Research Laboratory-LIM 41, Orthopedics and Traumatology Institute, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Raul Bolliger
authors.initials: RB
authors.lastname: Neto
authors.affiliation: Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: felipe.fregni@mgh.harvard.edu.
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.affiliation: Physical and Rehabilitation Medicine Institute (IMREA), Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Linamara Rizzo
authors.initials: LR
authors.lastname: Battistella
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000008:administration & dosage*; D059350:Chronic Pain / Q000188:drug therapy; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007278:Injections, Spinal / Q000379:methods*; D008012:Lidocaine / Q000008:administration & dosage*; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: Randomized clinical trial; central sensitization; evidence-based medicine; nonspecific chronic low back pain; paraspinous lidocaine injection
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