Chronic Mechanical Low Back Pain Research Articles

Application of restorative neurostimulation for chronic mechanical low back pain in an older population with 2-year follow up

IntroductionData on the Medicare-aged population show that older patients are major consumers of low back pain (LBP) interventions. An effective approach for patients with mechanical LBP that has been refractory...

Efficacy of kinesio tape added to lumbar stabilization exercises on adult patients with mechanical low back pain: A randomized, single-blind clinical trial

BackgroundLumbar stabilization exercises (LSEs) are beneficial for chronic mechanical low back pain (CMLBP). However, further research focusing on intervention combinations is recommended. This study examined the effect of kinesio tape (KT) with LSEs on CMLBP adult patients. MethodsA randomized blinded clinical trial was conducted. Fifty CMLBP patients of both genders were assigned into one of two groups and received 8 weeks of treatment: group A (control): LSEs only, and group B (experimental): KT with LSEs. The primary outcome was back disability, measured by the Oswestry disability index. Secondary outcomes included pain intensity, trunk extensor endurance, and sagittal spinal alignment, as indicated by the visual analog scale, Sorensen-test, and C7–S1 sagittal vertical axis, respectively. The reported data was analyzed by a two-way MANOVA using an intention-to-treat procedure. ResultsMultivariate tests indicate statistically significant effects for group (F = 4.42, p = 0.005, partial η2 = 0.148), time (F = 219.55, p < 0.001, partial η2 = 0.904), and group-by-time interaction (F = 3.21, p = 0.01, partial η2 = 0.149). Univariate comparisons between groups revealed significant reductions in the experimental group regarding disability (p = 0.029, partial η2 = 0.049) and pain (p = 0.001, partial η2 = 0.102) without a significant difference in the Sorensen test (p = 0.281) or C7–S1 SVA (p = 0.491) results. All within-group comparisons were statistically significant (p < 0.001). ConclusionThe combination of KT and LSEs is an effective CMLBP treatment option. Although patients in both groups displayed significant changes in all outcomes, the combined interventions induced more significant reductions in back disability and pain intensity.

Core stabilization exercises versus yoga on feedforward activation of core muscles in chronic mechanical low back pain: An experimental study

Core stabilization exercises versus yoga on feedforward activation of core muscles in chronic mechanical low back pain: An experimental study

Effects of Movement Retraining and Lumbar Stabilization Exercises in Mechanical Low Back Pain: A Pilot Study.

Objective To determine and compare the effects of movement retraining (MR), lumbar stabilization exercises (LSE), and a combination of both these exercises on pain, flexibility, strength, and functional disability in chronic mechanical low back pain (CMLBP) patients. Materials and methods Fifteen CMLBP participants, aged 20-40 years, were randomly allocated into three groups. Group A (n=5) received MR, group B (n=5), LSE, and group C (n=5), a combination of MR and CSE, along with hot packs for eight weeks, thrice a week on alternate days. Outcomes used were the Numerical Pain Rating Scale (NPRS), Modified Modified Schober's Test (MMST), Pressure Biofeedback (PBU), Roland Morris Disability Questionnaire (RMDQ), and Movement Control (MC) dissociation tests to identify MC impairments and were assessed at pre-intervention, post-four weeks, and post-eight weeks. The data were analyzed using repeated measures ANOVA. The level of significance was considered at p-value<0.05. Results Participants with CMLBP significantly improved in all variables in all three groups (p-value≤0.05). On inter-group comparison, group A showed better improvement in lumbar extension range of motion than the other two groups, with a mean difference of MMST in group A of 0.62±0.30, group B of 0.52±0.22, and group C of 0.36±0.02, with a p-value ≤0.002. Group C showed more improvement in core strength, with a mean difference of 5.0±0.25 in group A, 3.2±0.56 in group B, and 5.2±0.57 in group C, with a p-value ≤0.03. A significant improvement was observed in NPRS, MMST flexion, RMDQ, and uncontrolled movements (UCMs). Conclusion All three methods of treatment are effective in the management of CMLBP. Clinically, kinetic control showed better improvement in reducing pain and improving lumbar flexion and extension range of motion. Functional disability was better improved with lumbar stabilization exercises, and core strength was improved with a combination of KC and LSE. However, a combination of MR and LSE helps improve core strength, and movement retraining improves lumbar extension.

Effect of aerobic exercises on patients with chronic mechanical low back pain: A randomized controlled clinical trial

BackgroundChronic mechanical low back pain (CMLBP) is one of the most prevalent and costly disorders. Determining its most effective treatment approach is a priority for researchers. PurposeTo examine the effects of including aerobic exercise within a conventional therapy regimen for young adults with CMLBP. MethodsFifty CMLBP patients (22 males and 28 females) were randomly and equally assigned to one of two groups to receive the prescribed treatment for 8 weeks. The control group received the traditional program only (infrared, ultrasound, burst TENS, and exercises); for the experimental group, an aerobic training program using a stationary bicycle was added. Back pain intensity was the primary outcome. Secondary outcomes included the Oswestry disability index, back extensor endurance measured by the Sorensen test, and physical performance indicated by the back performance scale and the 6-min walk test. A Two-way MANOVA was used for data analysis. ResultsMultivariate tests revealed statistically significant effects of group (p = 0.002, partial η2 = 0.182), time (p < 0.001, partial η2 = 0.928), and group-by-time interaction (p = 0.01, partial η2 = 0.149). Univariate group-by-time interactions were significant for back disability (p = 0.043), extensor endurance (p = 0.023) and results of the 6-min walk test (p = 0.023) showing greater improvement in the experimental group. However, back pain intensity and the back performance scale revealed no significant group-by-time interactions. Within-group comparisons were significant for all measured variables in both groups (p < 0.001). ConclusionAlthough a traditional program of infrared, ultrasound, TENS, and exercises is beneficial for CMLBP treatment, adding aerobic exercises to the program leads to more beneficial outcomes.

Evaluation of effectiveness of osteopathic visceral manipulation in patients with chronic mechanical low back pain: A multi-center, single-blind, randomized-controlled study.

In this study, we aimed to evaluate the effectiveness of osteopathic visceral manipulation (OVM) combined with physical therapy in pain, depression, and functional impairment in patients with chronic mechanical low back pain (LBP). A total of 118 patients with chronic mechanical LBP were assessed, and 86 who met the inclusion criteria were included in the randomized-controlled study between January 2021 and August 2022. The patients were randomized to either Group 1 (n=43), which underwent physical therapy (5 days/week, for a total of 15 sessions) combined with OVM (2 days/week with three-day intervals), or Group 2 (n=43), which underwent physical therapy (5 days/week, for a total of 15 sessions) combined with sham OVM (2 days/week with three-day intervals). Both groups were assessed before and after treatment and at the fourth week post-treatment. Seven patients were lost to follow-up, and the study was completed with 79 patients (25 males, 54 females; mean age: 46.87±14.12 years; range, 19 to 75 years). Pain, depression, and functional impairment scores were all improved in both groups (p=0.001 for all). This improvement was sustained at week four after the end of treatment. However, improvement in the pain, depression, and functional impairment scores was significantly higher in Group 1 than in Group 2 (p=0.001 for all). The results suggest that OVM combined with physical therapy is useful to improve pain, depression, and functional impairment in patients with chronic mechanical low back pain. We believe that OVM techniques should be combined with other physical therapy modalities in this patient population.

The effect of additional transcutaneous auricular vagus nerve stimulation on back muscle endurance of chronic low back pain

Background: This study aims to investigate the effects of adding transcutaneous auricular vagus nerve stimulation (tVNS) to exercise therapy on back extensor muscle endurance of patients with mechanical chronic low back pain (CLBP). Methods: A randomized controlled group study was conducted on 22 patients with mechanical CLBP aged 16-55. Participants were randomized into an exercise group (control) and an exercise with a tVNS group (experimental). The outcome was back extensor muscle endurance measured by the Biering Sorensen Test (BST), evaluated before and after 2 weeks of intervention Results: There was a significant improvement in pre-post evaluation in the intervention group (before: 40.30± 31.20 and after: 66.49±45.87, p&lt;0.05), with a large effect size (Cohen’s d=0.918). No difference in pre-post evaluation in the control group (before: 58.18±50.75; after: 66.82±38.56; p&gt;0.05) with a small effect size (Cohen’s d=0.414). There was no significant difference between the delta BST of the two groups (p=0.418). Conclusion: Our results suggest that no difference was found between the two groups. However, tVNS addition to exercise therapy showed beneficial effects potency on back muscle endurance of the experimental group in CLBP patients during a relatively short period in two weeks of intervention. Further research is needed to confirm the potential of tVNS therapy in CLBP.

Effect of Aerobic Walking on Maximal Oxygen Consumption and Serum Vitamin D Levels in Patients with Mechanical Chronic Low Back Pain in Office Workers at Dr. Soetomo Hospital Surabaya

Background: Sedentary behavior is a common risk factor for mechanical chronic low back pain. Functional capacity and serum vitamin D levels are associated with low back pain intensity. The aim to analyze the effect of aerobic exercise walking on maximal oxygen consumption and serum vitamin D levels in patients with mechanical chronic low back pain. Method: true experimental with pre and post-test randomized control group design. Each group consisted of 16 respondents. The treatment group received additional aerobic exercise walking 3x/week, intensity 40-50% HRR (weeks 1-3), 50-60% HRR (weeks 4-6) and 60-80% HRR (weeks 7-8), 30 minutes per session for 8 weeks. The control group only received conventional training 3x/week for 8 weeks. The parameters evaluated were VO2 max and 25(OH)D. Measurements were taken before and after 8 weeks of intervention. Results: The VO2 max values of both groups increased with a significant difference after the intervention (p &lt; 0.001) and there was a difference in the difference (p &lt; 0.001). 25(OH)D levels in both groups increased with no significant difference after the intervention (p = 0.720) and no significant difference in the difference after the intervention (p = 0.662) Conclusion: There is a difference in the addition of walking aerobic exercise to conventional exercise compared to conventional exercise alone on maximal oxygen consumption, but there is no difference on serum vitamin D levels in mechanical chronic low back pain patients.

International Society for the Advancement of Spine Surgery Statement: Restorative Neurostimulation for Chronic Mechanical Low Back Pain Resulting From Neuromuscular Instability.

This International Society for the Advancement of Spine Surgery statement has been generated to respond to growing requests for background, supporting literature and evidence, and proper coding for restorative neurostimulation for chronic low back pain. Chronic low back pain describes the diverse experience of a significant proportion of the population. Conservative management of these patients remains the predominant care pathway, but for many patients, symptom relief is poor. The application of new techniques in patients who have exhausted traditional care paradigms should be undertaken with a detailed understanding of the pathology being treated, the mechanisms involved, and the data supporting efficacy. This statement on restorative neurostimulation places this technology in the context of the current understanding of the etiology of mechanical low back pain and the currently available evidence for this technique. In an appropriately selected cohort with a specific subset of chronic low back pain symptoms, this technique may provide benefit to payers and patients.

Restorative neurostimulation for chronic mechanical low back pain - Three year results from the United Kingdom post market clinical follow-up registry.

Mechanical chronic low back pain is often associated with impaired neuromuscular control of the lumbar multifidus muscles, the most important stabilizers of the lumbar spine. Restorative neurostimulation is a modality for the treatment for this specific subset of patients aimed to facilitate restoration of neuromuscular control by bilateral stimulation of the L2 medial branches. Evidence from both prospective and randomised clinical trials to date has demonstrated substantial improvements in clinical outcomes such as pain, disability and health-related quality of life. This study is an open label prospective follow-up for the treatment of chronic mechanical low back pain of nociceptive origin with restorative neurostimulation. Patients completed assessments for pain, disability and health-related quality of life. Outcomes were collected at 45, 90 and 180days, and 1, 2 and 3years after the activation visit. Forty-two patients were implanted with the device and 33 (79%) were available at the 3-year appointment. Patients in this cohort presented with severe chronic low back pain (NRS = 7.0 ± 0.2) and severe disability (ODI 46.6 ± 12.0). The health-related quality of life was also severely impacted at baseline (EQ-5D 0.426 ± 0.061). Changes in pain, disability and quality of life at three-year follow-up demonstrated a statistically significant improvement between baseline and 1, 2 and 3years. After 3years of therapy, average NRS scores had reduced to 2.7± 0.3 and mean ODI score to 26.0 ± 3.1 while EQ-5D-5L index improved to 0.707 ± 0.036. The ongoing follow-up of this post market cohort continues to demonstrate that restorative neurostimulation provides a statistically significant, clinically meaningful and durable response across pain, disability and quality-of life scores for patients suffering chronic mechanical low back pain that has been refractory to conventional management. ClinicalTrials.gov Identifier: NCT01985230.

ID: 218555 Feasibility of 18FDG-PET-CT assessment of Multifidus Activity and Radiomics based Heterogeneity analysis During Restorative Neurostimulation

Restorative neurostimulation for chronic mechanical low back pain relies on stimulation of the L2 medial branch of the dorsal ramus to elicit episodic tetanic contractions of the lumbar multifidus muscle in order to restore neuromuscular control of the lumbar spine. Quantification of metabolic activity, heterogeneity using PET uptake measurements and radiomic based texture analysis on 18F FDG-PET/CT provide a unique opportunity to visualize and quantify changes in the CNS and muscles in response to restorative neurostimulation therapy.

ID: 208698 Four-Year Durability of Restorative Neurostimulation Effectiveness in Patients With Refractory Chronic Low Back Pain

Mechanical chronic low back pain (CLBP) can be caused by impaired neuromuscular control of the lumbar spine stability. An implantable Restorative Neurostimulation system (ReActiv8® by Mainstay Medical) bilaterally stimulates the medial branches of the L2 dorsal rami for up to 30 minutes twice daily to override underlying inhibition of the multifidus muscles to facilitate motor control restoration. The ReActiv8-B randomized sham-controlled pivotal trial provided evidence of safety, effectiveness, and durability of this therapy (clinicaltrials.gov/show/NCT02577354).[1,2] Few if any prospective neuromodulation trials have shared efficacy, safety, and participant accountability outcomes beyond two years. Here we report the four-year results.

A comparison of the effects of connective tissue massage and classical massage on chronic mechanical low back pain.

The study aimed to compare the effects of connective tissue massage (CTM) and classical massage (CM) in patients with chronic mechanical low back pain on pain and autonomic responses and to determine the most effective manual therapy method. Seventy individuals with chronic mechanical low back pain were randomly divided into CTM (n = 35) and CM (n = 35) groups. The participants were given a 4-week treatment protocol consisting of a hot pack, exercise, and CTM or CM for 20 sessions. A visual analog scale was used to measure pain intensity. Heart rate, blood pressure, and skin temperature were measured for the evaluation of autonomic responses. In addition, disability (Oswestry disability index), quality of life (short form 36), and sleep quality (Pittsburgh sleep quality index) were evaluated. Participants were assessed before and after the 4-week treatment period as well as at the end of the 6-week follow-up period. In addition, visual analog index measurements were repeated at the end of each treatment week. Pain intensity was decreased in both groups (P < .05). However, CM was more effective than CTM at the end of the 2nd week (P < .05). In autonomic responses results, there were increases in peripheral skin temperatures in both groups (P < .05). Disability, quality of life, and sleep quality improved in both groups (P < .05). There were no differences between the groups relating to autonomic responses, disability, quality of life, and sleep quality (P > .05). The results of this study showed that massages were similar effect. The fact that CM is a frequently used technique in pain management and is as effective as CTM in autonomic responses will make it more preferred in the clinic.

ReActiv8 Stimulation Therapy vs. Optimal Medical Management: A Randomized Controlled Trial for the Treatment of Intractable Mechanical Chronic Low Back Pain (RESTORE Trial Protocol).

Chronic low back pain (CLBP) is the leading cause of years lived with disability globally. The role of restorative neurostimulation in the treatment of patients with refractory mechanical CLBP and multifidus muscle dysfunction has been established in one randomized controlled trial (RCT) and several clinical studies that demonstrated both safety and clinical benefit. This post-market trial provides a direct comparison to optimized medical management to test the hypothesis that the addition of restorative neurostimulation to current care paradigms results in significant improvements in back pain-related disability. This trial will include people who have reported significant levels of back pain and back pain-related disability with symptoms that have persisted for longer than 6months prior to enrollment and resulted in pain on most days in the 12months prior to enrollment. Eligible patients will be randomized to either optimal medical management or optimal medical management plus ReActiv8® restorative neurostimulation therapy. Patient-reported outcomes will be collected at regular intervals out to the 1-year primary endpoint, at which time the patients in the control arm will be offered implantation with the ReActiv8 system. Assessment of each group will continue for an additional year. The RESTORE trial follows the principles of the Declaration of Helsinki. The WCG IRB acts as the Central Institutional Review Board (IRB) for most sites and some sites will receive local IRB approval prior to enrollment of patients. Each IRB assessed the protocol and related documentation. The protocol complies with Good Clinical Practice (GCP). All patients provide written informed consent to participate in the trial. Version C, 07 Sep 2022. gov registration number. NCT04803214 registered March 17, 2021.

Effect of instrument assisted soft tissue mobilization versus kinesiotape for chronic mechanical low back pain: a randomized controlled trial

IntroductionThe primary purpose was to compare the effect of conventional program, instrument assisted soft tissue mobilization (IASTM) and kinesiotape (KT) in patients with chronic mechanical low back pain (CMLBP).Methods51 participants were randomly enrolled into three equal groups. Group A (&lt;i&gt;n&lt;/i&gt; = 17) received conventional program, Group B (&lt;i&gt;n&lt;/i&gt; = 17) received conventional program plus IASTM, and Group C (&lt;i&gt;n&lt;/i&gt; = 17) received conventional program plus KT. The participants were evaluated before and after eight sessions using the Visual Analogue Scale (VAS), pressure algometer, dual inclinometer, and Oswestry Disability Index (ODI).ResultsBetween pre-treatment and post-treatment, the three groups demonstrated a significant pain reduction (57.2%, 61.2%, and 57.77%; &lt;i&gt;p&lt;/i&gt; &lt; 0.0001), a significant increase in pain pressure threshold (PPT) [right (Rt): 56%, 53.2%, and 35.6%; left (Lt): 49%, 50.55%, and 41.36%; &lt;i&gt;p&lt;/i&gt; &lt; 0.0001], a significant improvement in the range of motion (ROM) (flexion: 38.59%, 43.55%, and 35.7%; extension: 72.4%, 88.73%, and 65.56%; Rt lateral flexion: 79.05%, 78.03%, and 55.42%; Lt lateral flexion: 85.33%, 96.37%, and 64.66%; Rt rotation 135%, 116.5%, and 188.48%; Lt rotation: 203%, 140.48%, and 224.24%; &lt;i&gt;p&lt;/i&gt; &lt; 0.0001), and a significant improvement in the functional disability index (56.8%, 49.55%, and 46.99%; &lt;i&gt;p&lt;/i&gt; &lt; 0.0001). No significant difference in pain, PPT, ROM and function was found among the three groups.ConclusionsConventional program, IASTM and KT are effective methods for improving pain, ROM and function on CMLBP.

Effectiveness and Durability of Restorative Neurostimulation in Patients with Mechanical Chronic Low Back Pain and Grade-1 Listhetic Segments and other Non-Surgical Spine Pathologies

Effectiveness and Durability of Restorative Neurostimulation in Patients with Mechanical Chronic Low Back Pain and Grade-1 Listhetic Segments and other Non-Surgical Spine Pathologies

A multi-center, double-blind, randomized parallel-group Phase IV study comparing the efficacy and safety of thiocolchicoside ointment versus placebo in patients with chronic mechanical low back pain and an acute muscle spasm.

This study aims to evaluate the efficacy and safety of thiocolchicoside (TCC) ointment treatment compared to placebo in patients with chronic mechanical low back pain (LBP) accompanied by acute muscle spasms. A total of 292 adult patients (106 males, 186 females; mean age: 38.5±11.2 years; range, 18 to 64 years) were randomized to TCC group (n=147) and placebo group (n=145) in 12 centers between March 2020 and March 2021. Eight patients from each group were excluded from the analysis. The primary endpoint was pressure pain threshold (PPT) on Day 3, which was measured using a pressure algometer. Secondary endpoints were PPT on Day 7, patient, and physician Visual Analog Scales-pain (VAS-pain) on Days 3 and 7, and safety. The PPT values on Day 3 was not significantly different between the treatment groups (p=0.701). Similarly, TCC and placebo group had similar VAS-pain scores over trial period (p=0.577 or higher for comparisons). Significantly higher PPT values and lower VAS-pain scores on Days 3 and 7 were observed in both groups (p<0.001 for all). In patients with a PPT value of ≥3.87, TCC arm had higher PPT on Day 3 compared to placebo (p=0.029). Three patients (two in the TCC arm and one in the placebo arm) discontinued the trial due to an adverse event. Topical TCC can be an appropriate option in a subset of patients with mild chronic LBP accompanied by muscle spasms. In a subset of patients with milder pain intensity, topical TCC may improve pain earlier. The results of this trial are compatible with the treatment approaches used in daily practice.

Three-year durability of pain and disability improvements in patients treated with Restorative Neurostimulation for chronic mechanical low back pain

Introduction: Mechanical chronic low back pain (CLBP) can be caused by impaired neuromuscular control and degeneration of the multifidus muscles, the most important stabilizers of the lumbar spine. An implantable Restorative Neurostimulation system (ReActiv8® by Mainstay Medical) bilaterally stimulates the medial branches of the L2 dorsal rami to override underlying multifidus inhibition to facilitate motor control restoration. The ReActiv8-B randomized sham-controlled pivotal trial provided published evidence of safety, effectiveness, and durability of this therapy (clinicaltrials.gov/show/NCT02577354).

Comparison between Mulligan Sustained natural apophyseal glides (snags) VS McKenzie exercises in Chronic Mechanical Low back pain

Background: Low back pain is a common musculoskeletal problem of the modern society as 70-80% people of any age and gender get affected by this in their lifetime which affect their normal activities of daily living. Aim: To compare the efficacy between Mulligan SNAGs and McKenzie exercises in improving pain level, range of motions and functional status in chronic mechanic al low back pain patients. Method: A randomized control trial study was conducted on 45 patients suffering from chronic mechanical low back pain at Physiotherapy Department of Mayo Hospital Lahore from16th December to 21th January 2021.The patients were randomly allocated in three group’s i.e; Conventional and two trial groups by computerized generated list. In Conventional group; 15 patients were treated with conventional therapy. In trial groups; one was treated with Mulligan SNAGs and Conventional therapyand the other trial group were treated with McKenzie exercises and Conventional therapy 3 sessions per week. Pain measured by Numeric Pain Rating Scale (NPRS), Lumbar spine's ranges measured by Goniometer and functional status measured by Oswestry Disability Index (ODI) at the completion of the 4 weeks treatment session. Results: NPRS scoring and Ranges showed significant improvement in all groups but NPRS significantly improved in McKenzie exercises group and significant improvement in ROM showed in Mulligan SNAGs group in all movements but there was no significant difference found between three groups comparison in improving the functional status with p-value =0.243. Practical implication: The study provides the opportunity to the patients to consider physiotherapy as an effective treatment for the mechanical low back pain. It also provides the statistical knowledge about these physiotherapy techniques and their effectiveness in treating the low back pain. Conclusion: Both the Mulligan SNAGs and McKenzie exercises are effective in treatment of Chronic lumbar pain as pain is most reduced through McKenzie exercise (3.33±1.29, p&lt;0.000) while ranges of spine is improved through Mulligan SNAGs mobilization in all directions. Keywords: Chronic Mechanical Low back pain, Mulligan SNAGs mobilization, McKenzie exercises

The level pro-inflammatory and anti-inflammatory biomarkers in patients with chronic mechanical low back pain under pulse radiofrequency therapy

Low back pain is a frequent and recurrent condition, often with a non-specific cause. Conventional treatment methods are generally insufficient in the treatment of chronic low back pain. The aim of the study was to estimate the level of IFN, IL-1, IL-6 (proinflammatory), IL-10, IL-4 (anti-inflammatory) and VEGF proteins in the serum of patients with chronic mechanical low back pain under Pulse radiofrequency (PRF) therapy. The study was carried out on 40 patients 20-60 years old, diagnosed with chronic low back pain for at least 4 months, primary complaint on lumbosacral low back pain, pain intensity VAS (visual analog scale) score of 5 and above, not responding well to conservative treatment (analgesic drugs, physiotherapy, etc.). Therapeutic Radiofrequency applications were carried out with an RF generator (RFG 3C Plus, Radionics). Blood samples were taken 1 day before interventional treatment (control), then 1 day (group1) and 15 days (group 2) after. The serum level of IFN, IL-1, IL-6, IL-10, IL-4 and VEGF l was analyzed with ELISA test. It was shown that as a result of PRF treatment the level of IL-1 was decreased while the levels of IL-4 and IL-6 were increased. It was concluded that the increase in serum levels of proinflammatory cytokines may be correlated with the severity of pain and that the increase in the level of anti-inflammatory cytokines reduces pain by reducing inflammation. Keywords: chronic low back pain, cytokines, radiofrequency therapy