[Acupuncture and other forms of treatment for patients with chronic back pain]

As in all pain sites, one has to distinguish between acute and chronic pain in spinal pain syndromes. The treatment of chronic spinal pain is dominated by non-operative procedures. There are three main procedures in this field of treatment: the manual medicine, the therapeutic application of local anesthetics and acupuncture. By manual techniques the pain-producing spinal structures can be recognized and these techniques offer at the same time sufficient treatment options to the patients. Therefore, manual therapeutic strategies are applied at first in a treatment session followed by the therapeutical application of local anesthetics. With this treatment the pain-producing spinal sites are directly influenced with the aim of blocking the nociceptors. Acupuncture is the last step of the treatment cascade in out patients in any case, because acupuncture does not only serve as treatment option for pain relief, but also and even more so has an harmonizing effect upon physical and psychological disturbances. It is absolutely necessary for the patient to lie down for 25 to 30 minutes to reach these goals. More invasive methods are offered to patients unsuccessfully treated by the described methods. These are: X-ray conducted periradicular infiltration, epidural blockades with local anesthetics and steroids, hiatus sacralis blockade, percutaneous radiofrequency denervation of the facet joint and percutaneous lumbar radiofrequency sympathicotomy. The indications for these treatment modalities are discussed as well as technical details regarding the performance. Disc herniation with radicular symptoms, spinal canal stenosis, cervical stenotic myelopathy and degenerative spinal instability may represent indications for surgical intervention. The symptomatology of these diseases is described. The indications for the individual cases and circumstances are discussed. Lastly, the various operative techniques are also described shortly.