Randomized controlled trials in industrial low back pain relating to return to work. Part 2. Discogenic low back pain

Area of Science:

• Orthopedics
• Rehabilitation Medicine
• Evidence-Based Medicine

Background:

• Discogenic low back pain (LBP) is a common condition impacting work capacity.
• Evaluating treatment efficacy for return to work (RTW) is crucial for patient outcomes and economic impact.

Purpose of the Study:

• To determine the efficacy of treatments for discogenic LBP using return to work (RTW) as the primary endpoint.
• To review randomized controlled trials (RCTs) published between 1975 and 1993.

Main Methods:

• Systematic literature search of LBP citations, followed by screening of nearly 600 articles.
• Inclusion of 35 studies meeting selection criteria, with 13 RCTs focusing on discogenic LBP with sciatica.
• Assessment of treatment interventions including chemonucleolysis, surgical discectomy, and epidural steroid injection using a 26-point quality scoring system.

Main Results:

• Nine of the 13 RCTs were deemed appropriate for analysis, focusing on radiologically confirmed discogenic LBP.
• The reviewed treatments included chemonucleolysis, surgical discectomy, and epidural steroid injections.
• A significant need for further research comparing various interventions was identified.

Conclusions:

• Current evidence from RCTs on treatments for discogenic LBP with RTW as an endpoint is limited.
• Additional high-quality studies are required to compare surgery, conservative care, epidural steroids, and traction for discogenic LBP.
• Further research is essential to establish optimal treatment strategies for improving return to work in patients with discogenic LBP.