A 50-year-old man with chronic low back pain

JAMA. 2008 May 7;299(17):2066-77. doi: 10.1001/jama.299.13.jrr80002. Epub 2008 Apr 1.


Mr S, a 50-year-old man, has long-standing low back pain. His pain began more than 20 years earlier with a lumbar disk herniation and has persisted despite diskectomy. He has undergone numerous treatments, but he remains disabled with ongoing pain. His treatment course is used to frame the epidemiology and pathophysiology underlying acute and chronic lumbosacral and radicular pain. The roles of neuropathic pain medications, chronic opioid therapy, physical therapy, spinal manipulation, and multidisciplinary pain treatment programs are reviewed. The indications for and outcomes associated with interventional pain treatments, including epidural steroid injection, facet blocks and radiofrequency treatment for facet-related pain, intradiskal electrothermal therapy, spinal cord stimulation, and intrathecal drug delivery, are discussed. Clinicians are given an evidence-based approach to using available treatment options for low back pain.

Publication types

  • Case Reports
  • Clinical Conference
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acupuncture Therapy
  • Analgesics, Opioid
  • Catheter Ablation
  • Cognitive Behavioral Therapy
  • Glucocorticoids
  • Humans
  • Intervertebral Disc Displacement / physiopathology
  • Intervertebral Disc Displacement / therapy
  • Low Back Pain / epidemiology
  • Low Back Pain / etiology
  • Low Back Pain / physiopathology
  • Low Back Pain / therapy*
  • Lumbar Vertebrae / anatomy & histology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Physical Therapy Modalities


  • Analgesics, Opioid
  • Glucocorticoids