Version June 2024
| Acupuncture | An intervention consisting of the insertion of needles at specific acupuncture points. |
| Artificial disc replacement | Replacement of a degenerated vertebral disc with an artificial (prosthetic) disc. |
| Back school | An intervention consisting of an education and a skills program, including exercise therapy, in which all lessons are given to groups of patients and supervised by a paramedical therapist or medical specialist. |
| Biofeedback | The use of auditory and visual signals reflecting muscle tension or activity in order to inhibit or reduce the muscle activity. |
| Brief educational interventions | Individualized assessment and education about low back pain problems without supervised exercise therapy or other specific interventions. |
| Chemonucleolysis | Treatment of herniated discs with intradiscal injections of an enzyme extracted from papaya (chymopapain). Chymopapain acts by digesting the jelly-like inner portion of the disc, known as the nucleus pulposus, while at the same time leaving the outer portion, the annulus fibrosis, essentially intact. Collagenase (which may be less likely to induce an allergic reaction) has also been used. |
| Cognitive behavioral therapy | An intervention that involves working with cognitions to change emotions, thoughts, and behaviors. |
| Discectomy | Removal of all or parts of an intervertebral disc in order to relieve pressure on adjacent nerve roots. |
| Epidural steroid injection | An intervention that involves the administration of steroids in the space between the dura and the spine via catheter. Epidural injections can be performed by the translaminar approach (via the interlaminar space in the spine), the transforaminal approach (through the neuroforamen ventral to the nerve root), or the caudal approach (through the sacral hiatus at the sacral canal). |
| Exercise therapy | A supervised exercise program or formal home exercise regimen, ranging from programs aimed at general physical fitness or aerobic exercise to programs aimed at muscle strengthening, flexibility, stretching, or different combinations of these elements. |
| Facet joint injection | Injection of a glucocorticoid into the facet joints in order to reduce inflammation and/or swelling. |
| Functional restoration (also referred to as work hardening or work conditioning) | An intervention that involves simulated or actual work tests in a supervised environment in order to enhance job-performance skills and improve strength, endurance, flexibility, and cardiovascular fitness in injured workers. |
| Fusion surgery | A surgical procedure that unites (fuses) two or more vertebra together. The goal behind fusion surgery is to restrict spinal motion in order to relieve symptoms. A variety of spinal fusion techniques are practiced. All involve the placement of a bone graft between the vertebrae. In addition, fusion can be performed with or without the use of supplemental hardware (instrumentation), such as plates, screws, or cages that serve as an internal splint while the bone graft heals. |
| Interdisciplinary therapy (also referred to as multidisciplinary therapy) | An intervention that combines and coordinates physical, vocational, and behavioral components and is provided by multiple health care professionals with different clinical backgrounds. The intensity and content of interdisciplinary therapy varies widely. |
| Interferential therapy | The superficial application of a medium frequency alternating current modulated to produce low frequencies up to 150 Hz. |
| Intradiscal glucocorticoid injection | Injection of a glucocorticoid directly into a lumbar disc in order to reduce swelling and inflammation. |
| Intradiscal electrothermal therapy (IDET) | An intervention involving the placement of an electrode into the intervertebral disc in patients with presumed discogenic back pain. The catheter is slowly heated and kept at a predetermined temperature for a predetermined time in order to coagulate and shrink adjacent tissues. |
| Laminectomy | Removal of the vertebral lamina in order to relieve pressure on the spinal cord or nerve roots. |
| Local injections | Injections into the soft tissues surrounding the back with a local anesthetic, sometimes with a glucocorticoid. A variety of target sites have been proposed, including tender points and various anatomic sites. |
| Low-level laser therapy (LLLT) | The superficial application of lasers at wavelengths between 632 and 904 nm. Optimal treatment parameters (wavelength, dose, dose-intensity) are uncertain. |
| Massage | Soft tissue manipulation using the hands or a mechanical device through a variety of specific methods. |
| Medial branch block | Injection of a local anesthetic (with or without a glucocorticoid) into the area of the nerve innervating the facet joint. Medial branch blocks may be used diagnostically (to determine whether the facet joint is the source of back pain) or therapeutically. |
| Percutaneous electrical nerve stimulation (PENS) | An intervention involving the insertion of acupuncture-like needles and applying low-level electrical stimulation. It differs from electroacupuncture in that the insertion points target dermatomal levels for local pathology, rather than acupuncture points. |
| Percutaneous intradiscal radiofrequency thermocoagulation (PIRFT) | An intervention similar to IDET, this intervention involves insertion of an electrode or catheter into the intervertebral disc. Unlike IDET, the electrode or catheter itself does not become hot. Instead, heat is generated in surrounding tissues by an alternating radiofrequency current. |
| Progressive relaxation | A technique that involves the deliberate tensing and relaxation of muscles in order to facilitate the recognition and release of muscle tension. |
| Provocative discography | A procedure involving injection of radiographic contrast material into the nucleus of an intervertebral disc, which may elicit pain. It is most commonly performed in patients with chronic low back pain in order to help identify those who are more likely to benefit from interventional procedures intended to treat "discogenic" back pain. |
| Radiofrequency denervation | Destruction of nerves using heat generated by a radiofrequency current. It involves the placement of a catheter or electrode near or in the target nerve. Once the position of the catheter is confirmed by fluoroscopy, a radiofrequency current is applied in order to heat and coagulate adjacent tissues, including the target nerve. |
| Sacroiliac joint injection | Injection of glucocorticoid into the area near the sacroiliac joint in order to reduce inflammation and/or swelling. |
| Shortwave diathermy | Therapeutic elevation of the temperature of deep tissues by application of shortwave electromagnetic radiation with a frequency range from 10 to 100 MHz. |
| Spinal manipulation | Manual therapy in which loads are applied to the spine using short- or long-lever methods. High-velocity thrusts are applied to a spinal joint beyond its restricted range of movement. Spinal mobilization, or low-velocity, passive movements within or at the limit of joint range, is often used in conjunction with spinal manipulation. |
| Transcutaneous electrical nerve stimulation (TENS) | Use of a small battery-operated device to provide continuous electrical impulses via surface electrodes, with the goal of providing symptomatic relief by modifying pain perception. |
| Yoga | An intervention distinguished from traditional exercise therapy by the utilization of specific body positions, breathing techniques, and emphasis on mental focus. Many styles of yoga are practiced, each emphasizing different postures and techniques. |
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