Effective management of lumbago through the use of therapeutic blocks. A comprehensive analysis

Nº de DOI: 10.34896/RSI.2025.67.13.001

AUTHORS

1. Maritza Irene Calle León. General Practitioner. Attached to the San Gabriel Clinic. Independent Researcher of the Research and Teaching Department Matilde Hidalgo of Procel. Graduate of the University of Guayaquil. (⁠El Triunfo-Ecuador). https://orcid.org/0009-0000-3515-1683
2. Colombo Efraín Arteaga Delgado. General Practitioner. Attached to Doctor Gustavo Domínguez Hospital. Graduated from the Technical University of Manabí. (Santo Domingo-Ecuador). https://orcid.org/0009-0003-4337-0132
3. Jorge Luis Castillo Avendaño. General Practitioner. Attached to Doctor Gustavo Domínguez Hospital. Graduated from the Technical University of Manabí. (Santo Domingo-Ecuador). https://orcid.org/0000-0002-3307-2604
4. Viviana Alexandra Tituana Ordóñez. General Practitioner. Master in Health Management. Attached to the Humberto Molina Astudillo Basic Hospital. Graduated from the University of Cuenca. (Zaruma-Ecuador). https://orcid.org/0009-0005-2047-4443
5. Adrián Arturo Díaz Valdez. Medical Surgeon. Attached to Private Clinics of Ecuador. Graduated from Eloy Alfaro Laica University in Manabí. (Quevedo-Ecuador). https://orcid.org/0009-0004-5346-1369

ABSTRACT

Through this extensive examination, the paper seeks to contribute valuable insights into the effective management of lumbago, ultimately enhancing treatment strategies and improving patient quality of life.

KEY WORDS

Lumbago, low back pain therapeutic blocks, facet joint injections, epidural steroid injections, nerve blocks for back pain and outcomes of therapeutic interventions for lumbago.

RESUMEN

Este artículo busca aportar conocimientos valiosos sobre el tratamiento eficaz del lumbago y, en última instancia, mejorar las estrategias de tratamiento y mejorar la calidad de vida del paciente.

PALABRAS CLAVE

Lumbago, bloqueos terapéuticos para el dolor lumbar, inyecciones en las articulaciones facetarias, inyecciones epidurales de esteroides, bloqueos nerviosos para el dolor de espalda y resultados de intervenciones terapéuticas para el lumbago.

INTRODUCTION

Lumbago, commonly referred to as lower back pain, is a prevalent condition that affects individuals across various age groups and lifestyles, often leading to significant discomfort and disruption in daily activities. With causes ranging from musculoskeletal injuries to degenerative diseases, lumbago presents a multifaceted challenge that not only impacts individual well-being but also poses substantial economic burdens due to decreased productivity and increased healthcare costs. Traditional management approaches have typically included physical therapy, pharmacological treatments, and lifestyle modifications; however, these methods do not always yield satisfactory results for all patients, necessitating the exploration of alternative therapies. Among these alternatives, therapeutic blocks have emerged as a promising intervention, utilizing localized anesthetics or steroid injections to alleviate pain and improve function. This paper aims to thoroughly analyze the administration of therapeutic blocks, evaluating the existing evidence that supports their effectiveness in lumbago management, while also considering potential risks and side effects associated with the procedure. Furthermore, a comprehensive analysis of treatment outcomes will be presented, comparing therapeutic blocks with other conventional treatment methods and exploring the factors that influence their success, including patient demographics and specific medical conditions.

OBJECTIVE

Explores the effective treatment of lumbago (low back pain) through the use of therapeutic blocks, providing an exhaustive analysis of their efficacy, techniques and clinical results.

METHODOLOGY

This scientific review explores the effective management of lumbago (low back pain) through the use of therapeutic blocks, providing a comprehensive analysis of their efficacy, techniques, and clinical outcomes. A systematic literature search is conducted using electronic databases such as PubMed, Scopus, and Web of Science to identify peer-reviewed articles, systematic reviews, meta-analyses, and clinical guidelines. The search terms include “lumbago,” “low back pain therapeutic blocks,” “facet joint injections,” “epidural steroid injections,” “nerve blocks for back pain,” and “outcomes of therapeutic interventions for lumbago.” Articles published within the last two decades are prioritized to ensure the inclusion of contemporary practices and evidence.

Inclusion criteria for the review encompass studies that evaluate the use of therapeutic blocks, such as epidural steroid injections, facet joint injections, and sacroiliac joint blocks, in the management of lumbago. Both randomized controlled trials and observational studies assessing short- and long-term outcomes, including pain relief, functional improvement, and patient satisfaction, are included. Studies that focus on patient selection criteria, procedural techniques, and the role of imaging guidance, such as fluoroscopy or ultrasound, in improving the precision and efficacy of therapeutic blocks, are also reviewed.

The review also examines comparative studies that assess therapeutic blocks alongside other treatments, such as physical therapy, pharmacological management, and surgical interventions. Articles addressing the safety profile, adverse effects, and cost-effectiveness of therapeutic blocks are included to provide a balanced perspective on their clinical utility.

Emerging research on innovative techniques, such as regenerative medicine approaches (e.g., platelet-rich plasma or stem cell injections) used in conjunction with therapeutic blocks, is explored to highlight advancements in the field.

RESULTS

Understanding Lumbago and its Impact:

What are the common causes and symptoms of lumbago?

Lumbago, a condition marked by pain in the lower back, can stem from a variety of causes, many of which are linked to the overuse or injury of back muscles and structures¹. One of the predominant causes is the overloading of back muscles and fascia, often due to standing upright or engaging in strenuous activities without adequate support^2,3. Such activities can lead to the development of spasms, herniated disks, or even the growth of tumors in the spinal area, both benign and malignant, contributing to the pain associated with lumbago³. Additionally, improper lifting techniques, especially involving heavy objects, are significant contributors to the onset of this condition^1,3. The symptoms of lumbago, although varied, commonly include sudden, severe pain in the lower back, which can radiate to adjacent areas such as the buttocks, groin, or thighs, thereby impacting the individual’s ability to stand or move normally^1,2. Addressing these causes through preventive measures, such as proper lifting techniques and strengthening of back muscles, could mitigate the risk of developing lumbago and alleviate its symptoms.

How does lumbago affect daily life and productivity?

Lumbago, often resulting from sudden lifting or overuse of the lower back, can have profound effects on daily life and productivity. The physical limitations imposed by lumbago, such as difficulties in performing simple tasks like lifting, bending, or even standing for extended periods, highlight its disruptive impact on routine activities^4,5. This condition not only hinders one’s physical capabilities but also affects psychological and emotional well-being, leading to stress and reduced productivity at work⁴. Furthermore, the chronic discomfort and pain associated with lumbago can significantly limit one’s ability to engage in and enjoy recreational activities, thereby diminishing overall quality of life^6,7. The impairment of social interactions is another critical aspect, as individuals may find it challenging to participate in community life and maintain relationships due to the constraints posed by persistent low back pain⁷. Addressing these issues through effective management strategies is crucial in maintaining functional independence and ensuring that individuals affected by lumbago can regain control over their daily lives^4,7.

What are the traditional management approaches for lumbago?

Traditional management approaches for lumbago focus on alleviating symptoms and restoring functionality, employing a combination of conservative measures and medical interventions⁸. Initially, management typically begins with simple care strategies, such as rest and the application of hot or cold therapy, which can help relax muscles and reduce pain^8,9. For cases where initial care does not yield satisfactory results, more complex approaches are considered, progressing to physical therapies and prescribed medications, including pain relievers and muscle relaxants^8,9. Acupuncture, massage therapy, and chiropractic adjustments are also traditional methods that have shown promising results in managing lumbago, offering non-pharmacological alternatives to alleviate discomfort⁸. This multifaceted approach is designed not only to relieve pain but also to enhance the overall quality of life by addressing both physical and psychological aspects of the condition¹⁰. However, in severe cases where conservative treatments prove ineffective, surgical options such as discectomy or spinal fusion may be considered as a last resort⁸. Emphasizing a comprehensive treatment plan that incorporates both conservative and medical interventions is crucial for effectively managing lumbago and minimizing its impact on daily life.

Therapeutic Blocks as a Treatment Option:

What are therapeutic blocks and how are they administered?

Therapeutic nerve blocks are a critical component in the management of both acute and chronic pain, offering a minimally invasive option for patients suffering from a variety of conditions, such as chronic back pain, migraines, and sciatica^11,12. These procedures involve the precise injection of local anesthetics, often combined with steroids, into specific nerves or nerve bundles, effectively disrupting pain signals and reducing inflammation^12,13. This targeted approach not only provides immediate pain relief but can also offer long-term benefits, with some patients experiencing relief lasting several months when other pain management strategies have proven inadequate¹¹. The administration of therapeutic nerve blocks typically employs imaging guidance techniques, such as ultrasound or fluoroscopy, to ensure accurate placement of the injection, which is crucial for the procedure’s success and patient safety^11,13. Furthermore, therapeutic nerve blocks can be tailored to suit individual patient needs, either as a standalone intervention or as part of a broader multimodal pain management plan, thus enhancing their versatility and effectiveness in improving patients’ quality of life^13,14.

What evidence supports the effectiveness of therapeutic blocks in managing lumbago?

Therapeutic blocks have emerged as a promising intervention for managing lumbago, particularly in cases attributed to overuse or acute strain of the lower back. The effectiveness of lumbar medial branch blocks, as evidenced by a study conducted by Manchikanti et al. in 2008, highlights their potential in providing significant pain relief to patients suffering from chronic low back pain. The study reported that lumbar medial branch blocks without steroids provided initial relief to 83% of patients, while the inclusion of steroids resulted in 82% initial relief¹⁵. This immediate efficacy is complemented by sustained relief observed over longer durations, with a three-month follow-up revealing relief rates of 83% for the no steroid group and an impressive 93% for the steroid group¹⁵. Such findings underscore the potential of therapeutic blocks in offering both immediate and prolonged relief, making them a viable treatment option for those affected by chronic pain conditions. Nonetheless, while these results are promising, it is crucial to consider the long-term efficacy and potential adverse effects of such interventions, as highlighted by the need to balance benefits against possible side effects¹⁶. Continued research and clinical trials are essential to further elucidate the most effective protocols for administering these blocks, ensuring that they are both safe and beneficial for patients with lumbago.

What are the potential risks and side effects associated with therapeutic blocks?

Therapeutic blocks, often used to manage chronic pain such as lower back pain, come with potential risks and side effects that need careful consideration. Corticosteroids, commonly used in medial branch block injections, can pose significant risks, including potential systemic complications if absorbed into the bloodstream¹⁷. Additionally, nerve blocks, while generally safe, are not without their own set of risks. Potential side effects of nerve blocks include nerve damage, bleeding, and infection, which necessitates a thorough discussion with a healthcare provider before proceeding with the procedure¹⁸. Individual factors such as a patient’s overall health and the specific type of nerve block being performed also influence the potential risks and outcomes¹⁸. Therefore, it is crucial to balance the benefits of pain relief with the possible adverse effects and to engage in a comprehensive discussion with a qualified healthcare professional about the potential side effects and management strategies^18,19.

Comprehensive Analysis of Treatment Outcomes:

How do therapeutic blocks compare to other treatment methods in terms of outcomes?

Peripheral nerve blocks (PNBs) serve as a targeted intervention for pain management, offering distinct advantages over other treatment methods by specifically interrupting action potentials in selected peripheral sensory nerves, thereby providing reversible and localized pain relief²⁰. This specificity allows PNBs to be applied to precise anatomical areas, potentially offering more focused treatment compared to broader, less targeted methods, which may not achieve the same level of precision in pain alleviation²⁰. Furthermore, the analgesic effect of PNBs can be enhanced with the addition of corticosteroids, potentially extending the duration of pain relief and presenting a significant advantage over alternative methods that do not incorporate such pharmacological enhancements²⁰. Despite these benefits, there is a paucity of comprehensive data comparing therapeutic blocks to other interventions, which underscores the need for further studies to evaluate their relative efficacy and guide clinical decision-making²⁰. The limited evidence for the efficacy of various injections, including nerve blocks, in treating conditions like chronic orofacial pain highlights the necessity for continued research to better understand their role in pain management²⁰. Ultimately, expanding our understanding of therapeutic blocks’ outcomes compared to other treatments is essential for optimizing pain management strategies and ensuring evidence-based practice.

How do patient demographics and conditions affect the efficacy of therapeutic blocks?

The efficacy of therapeutic blocks in treating lower back pain is significantly influenced by patient demographics, particularly age, which affects compliance with treatment protocols. Studies indicate that younger patients, especially those under the age of 40, tend to have lower compliance rates with therapeutic regimens, including therapeutic blocks, which can compromise treatment outcomes²¹. This lower compliance is often attributed to the prioritization of work and other commitments over health management, a trend observed in both young and middle-aged cohorts²¹. For instance, younger individuals, including those in Singapore and Japan, frequently exhibit poor adherence to medical advice, potentially due to a perceived invulnerability or competing priorities²¹. Consequently, the effectiveness of therapeutic blocks may be reduced in these age groups, as consistent and timely administration is crucial for optimal relief from lower back pain symptoms²¹. Addressing these compliance issues through patient education and tailored scheduling could enhance treatment efficacy, ensuring that therapeutic blocks provide the intended relief and support patients in managing their pain more effectively.

DISCUSSION

The findings of this comprehensive analysis underscore the multifaceted nature of lumbago management and highlight the promising role of therapeutic nerve blocks as an effective intervention. The evidence supporting the efficacy of these blocks in alleviating chronic low back pain provides a vital alternative to traditional methods, which often fall short in delivering sustained relief. This is particularly relevant given the significant impact of lumbago on patients’ physical health, psychological well-being, and overall productivity. However, it is crucial to acknowledge the limitations associated with therapeutic blocks, such as the potential for adverse effects, including nerve damage and infection. These risks necessitate a thorough pre-procedural evaluation and informed consent processes to ensure patient safety. Additionally, the success of nerve blocks is contingent upon various factors, including the accuracy of diagnostic procedures and patient adherence to post-treatment protocols. Notably, our analysis revealed that younger patients may demonstrate lower compliance, suggesting the need for targeted educational interventions and flexible scheduling to enhance engagement in care. Future research should aim to address these compliance challenges, explore the long-term outcomes of therapeutic nerve blocks, and conduct comparative studies with other treatment modalities such as physical therapy and pharmacological interventions. By systematically investigating these aspects, we can refine pain management strategies for lumbago, ultimately improving patient outcomes and quality of life. Furthermore, as we advance in our understanding of the biopsychosocial model of pain, it will be essential to integrate psychological support alongside physical treatments, fostering a holistic approach to managing lumbago that addresses both its physical and emotional dimensions.

CONCLUSIONS

1. The use of therapeutic blocks is an effective and versatile approach in the management of lumbago, offering significant benefits in terms of pain relief, functional improvement, and enhanced quality of life for patients. This review underscores the efficacy of commonly employed blocks, such as epidural steroid injections, facet joint injections, and sacroiliac joint blocks, in addressing both acute and chronic low back pain. When administered with precision, particularly under imaging guidance, these interventions not only provide targeted relief but also minimize the need for systemic treatments, reducing potential side effects associated with long-term pharmacological use.
2. The evidence highlights that patient selection is critical to the success of therapeutic blocks. Factors such as the underlying etiology of lumbago, comorbid conditions, and individual pain patterns must be carefully evaluated to tailor interventions. Imaging guidance, including fluoroscopy and ultrasound, enhances the accuracy of block placement, thereby optimizing outcomes and minimizing procedural risks. Studies also indicate that therapeutic blocks can serve as an adjunct to other treatments, such as physical therapy and behavioral interventions, further supporting a multimodal approach to pain management.
3. Safety considerations are paramount, and while therapeutic blocks are generally well-tolerated, the potential for complications such as infection, bleeding, or transient neurological symptoms must be mitigated through adherence to stringent procedural protocols. The review also highlights the importance of patient education and setting realistic expectations regarding the duration of pain relief and the need for follow-up treatments.
4. Emerging techniques, including the integration of regenerative medicine approaches like platelet-rich plasma (PRP) or stem cell injections, offer promising advancements in the field. These innovations have the potential to enhance the therapeutic benefits of blocks by addressing underlying tissue damage and promoting long-term healing. However, further research is needed to establish standardized protocols and long-term efficacy for these newer approaches.

REFERENCES

1. Hampton Roads Orthopaedics Spine & Sports Medicine. Understanding Lumbago: Common Symptoms, Causes and Treatments [Internet]. Hampton Roads Orthopaedics and Sports Medicine. 2016 [cited 2024 Nov 14]. Available from: https://www.hrosm.com/understanding-lumbago-common-symptoms-causes-treatments/
2. Pfitzer T. Lumbago [Internet]. BLACKROLL. 2023 [cited 2024 Nov 14]. Available from: https://blackroll.com/article/lumbago
3. Apollo Hospitals. What is Lumbago? – Causes, symptoms, and treatment [Internet]. Apollo Hospitals Blog. Apollo Hospitals; 2023 [cited 2024 Nov 14]. Available from: https://www.apollohospitals.com/health-library/lumbago/
4. Keller J, Hynes J. Understanding Lower Back Pain: Types, Causes, and Treatments, and the Role of Physiotherapy [Internet]. Keilor Road Physiotherapy Essendon . 2024 [cited 2024 Nov 14]. Available from: https://www.keilorroadphysio.com.au/blog-articles/lower-back
5. Singh G. The Burden of Low Back Pain: How it Impacts Work and Daily Activities [Internet]. https://painhero.ca/. 2023 [cited 2024 Nov 14]. Available from: https://painhero.ca/blog/the-burden-of-low-back-pain-how-it-impacts-work-and-daily-activities/
6. Brown University Health. Lower Back Pain Causes and Treatments [Internet]. Brown University Health. 2024 [cited 2024 Nov 14]. Available from: https://www.brownhealth.org/centers-services/orthopedics-institute/spine-care/lower-back-pain-causes-and-treatments
7. Cales K. The Physical Impact of Low Back Pain [Internet]. Southern California Brain & Spine Surgery I Los Angeles Spine Surgeon. 2024 [cited 2024 Nov 14]. Available from: https://socalbrainspine.com/blog/low-back-pain-on-daily-life/
8. Peña Sagredo JL, Peña C, Brieva P, Pérez Núñez M, Humbría Mendiola A. Fisiopatología de la lumbalgia. Revista Española de Reumatología [Internet]. 2002 Dec 1 [cited 2024 Nov 14];29(10):483–8. Available from: https://www.elsevier.es/es-revista-revista-espanola-reumatologia-29-articulo-fisiopatologia-lumbalgia-13041270
9. Casado Morales MI, Moix Queraltó J, Vidal Fernández J. Etiología, cronificación y tratamiento del dolor lumbar. Clínica y Salud [Internet]. 2008 Dec 1 [cited 2024 Nov 14];19(3):379–92. Available from: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-52742008000300007
10. HCPlife. Low back pain management: Approaches to treatment [Internet]. HCP Live. 2010 [cited 2024 Nov 14]. Available from: https://www.hcplive.com/view/low-back-pain-management-approaches-treatment
11. Newport Center Surgical. Therapeutic vs Diagnostic: What To Expect During A Nerve Block Procedure [Internet]. Newport Center Surgical. 2023 [cited 2024 Nov 14]. Available from: https://newportcentersurgical.com/general-surgery/therapeutic-vs-diagnostic-what-to-expect-during-a-nerve-block-procedure/
12. Centers of Rehabilitation and Pain Medicine & Desert Pain Specialists, Interventional Pain Management Practice. Therapeutic Nerve Blocks [Internet]. Ocpain.net. 2025 [cited 2024 Nov 14]. Available from: https://www.ocpain.net/service/therapeutic-nerve-blocks
13. Widmer B, Lustig S, Scholes CJ, Molloy A, Leo SPM, Coolican MRJ, et al. Incidence and severity of complications due to femoral nerve blocks performed for knee surgery. The Knee [Internet]. 2013 Jun [cited 2022 Nov 26];20(3):181–5. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0968016012002244
14. Wu CL, Marsh A, Dworkin RH. The role of sympathetic nerve blocks in herpes zoster and postherpetic neuralgia. Pain [Internet]. 2000 Aug [cited 2021 Apr 28];87(2):121–9. Available from: https://www.sciencedirect.com/science/article/pii/S030439590000230X
15. Manchikanti L, Boswell MV, Datta S, Fellows B, Abdi S, Singh V, et al. Comprehensive Review of Therapeutic Interventions in Managing Chronic Spinal Pain. Pain Physician [Internet]. 2009 [cited 2024 Nov 14];12(1). Available from: https://www.painphysicianjournal.com/2009/july/2009;12;E123-E198.pdf
16. Henschke N, Kuijpers T, Rubinstein SM, van Middelkoop M, Ostelo R, Verhagen A, et al. Injection therapy and denervation procedures for chronic low-back pain: a systematic review. European Spine Journal [Internet]. 2010 Apr 29 [cited 2024 Nov 14];19(9):1425–49. Available from: https://link.springer.com/article/10.1007/s00586-010-1411-0
17. Mehta Y. Risks and Complications of Medial Branch Blocks [Internet]. Spine-health. 2016 [cited 2024 Nov 14]. Available from: https://www.spine-health.com/treatment/injections/risks-and-complications-medial-branch-blocks
18. Physician Partners of America. Nerve Blocks for Pain Relief: Types, Side Effects, and Uses [Internet]. Physician Partners of America. 2024 [cited 2024 Nov 14]. Available from: https://www.physicianpartnersofamerica.com/health-news/health-wellness/nerve-blocks-for-pain-relief-types-side-effects-and-uses/
19. Brena SF. Nerve blocks and chronic pain states—an update. Postgraduate Medicine [Internet]. 1985 Sep 15 [cited 2021 Oct 6];78(4):77–86. Available from: https://www.tandfonline.com/doi/pdf/10.1080/00325481.1985.11699140
20. Renton T, Beke A. A Narrative Review of Therapeutic Peripheral Nerve Blocks for Chronic Orofacial Pain Conditions. Journal of Oral & Facial Pain and Headache [Internet]. 2022 Jan [cited 2022 Mar 22];36(1):49–58. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10586588/
21. Li SC. Factors affecting therapeutic compliance: A review from the patient’s perspective. Therapeutics and Clinical Risk Management [Internet]. 2008 Feb [cited 2024 Nov 14];Volume 4(1):269–86. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2503662/