Control of Acute Pain in a Patient with Acute Chronic Low Back Pain by Using Ecoguided Facetary Analgesic Blockin the Emergency Room, Report of Two Cases

Abstract

Low back pain is one of the most frequent causes of disability, it is a problem that is characterized by its high prevalence in the population and its economic and social repercussions, becoming one of the main causes of work absenteeism. In this entity, there is an association between muscular and psychosocial factors that generate avoidance behaviors, fear and muscle atrophy, causing a vicious circle that favors chronicity and disability. The prevalence of this syndrome is 60-85% during the survival of individuals. Between 15 and 20% of adults suffer from low back pain; in 90% of cases it is non-specific, it affects both men and women, and occurs more in ages between 30 and 50 years; increasing prevalence with age. The most important challenge in the diagnosis of low back pain is to differentiate the 95% whose origin is benign musculoskeletal processes, from the 5% whose low back pain is caused by specific diseases that require rapid and adequate treatment. In this task, the warning signs that help to rule out the most serious processes can be useful. The warning signs in low back pain are: age >50 years, history of neoplasia, constitutional syndrome, no improvement with usual treatments, pain at rest, fever, immunosuppression, previous trauma, osteoporosis, taking corticosteroids and cauda equina syndrome. It should also be noted that in approximately 80% of cases it will not be possible to arrive at a specific diagnosis. Thanks to advances in imaging, neural anatomical findings, new discoveries in the chemical mediation of pain, the development of ultrasound-guided injection techniques, we have greater diagnostic and therapeutic accuracy, and the highest success rate in non-surgical treatments have facilitated the expansion of minimally invasive techniques in pain management. On this occasion, two patients with pain at the level of the intense lumbar region are presented, who were managed with opioid analgesics, NSAIDs without pain improvement, in both cases ultrasound-guided fascetarian blocks were applied, with pain remission on a VAS scale of 10 /10 to 1/10, being discharged from the service.