Kawai Ryota, Komiya Eriko, Date Hisashi, Kamezawa Takashi, Nonomiya Yuta, Yoshida Hisako, Shintani Ayumi
Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, JPN.
Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, JPN.
Cureus. 2025 Jul 29;17(7):e88955. doi: 10.7759/cureus.88955. eCollection 2025 Jul.
Background Acute low back pain is a leading cause of disability worldwide. While clinical guidelines offer general management strategies, real-world evidence on nerve block therapy for acute low back pain in primary care remains limited. Methods We conducted a prospective, multicenter observational cohort study at 19 private pain clinics in Japan from June 2021 to March 2022. Patients with acute low back pain onset within the past seven days were enrolled and followed for seven days. Clinical decisions, including nerve block administration, were made at the physician's discretion. Patient-reported outcomes were collected via web- or paper-based questionnaires and compared between patients who received nerve block injections and those who did not. The primary outcome was the change in Pain Disability Assessment Scale (PDAS) scores from baseline to Day 3; secondary outcomes included PDAS changes on Day 7 and Visual Analog Scale (VAS) scores for seven consecutive days. Multivariable regression models were used to adjust for confounding factors. Results A total of 567 patients were analyzed (523 injected; 44 non-injected). Among patients with baseline PDAS scores ≥ 45, those who received injections showed significantly greater improvement on Day 3. The mean differences (95％ confidence interval (CI) ) in PDAS scores were -6.42 (-12.48 to -0.36) ( = 0.038) at a baseline score of 45, -11.95 (-21.35 to -2.55) ( = 0.013) at 50, and -17.54 (-31.01 to -4.07) ( = 0.011) at 55. VAS scores were significantly lower in patients with the injection on Day 1 (mean difference (95% CI): -0.70 (-1.37 to -0.04)) and Day 3 (-0.76 (-1.44 to -0.08)), with no significant differences beyond Day 3. Conclusion Nerve block therapy was associated with faster pain relief and earlier functional improvement in acute low back pain patients, particularly among those with greater baseline disability. These findings provide meaningful real-world evidence. Given the observational design and the fact that treatment decisions were made at the discretion of attending physicians, there remains a potential for selection bias. Further well-designed studies are needed to validate these findings and guide optimal treatment strategies for acute low back pain.
急性下腰痛是全球致残的主要原因。虽然临床指南提供了一般管理策略，但在初级保健中，关于急性下腰痛神经阻滞治疗的真实世界证据仍然有限。方法：我们于2021年6月至2022年3月在日本的19家私立疼痛诊所进行了一项前瞻性、多中心观察性队列研究。纳入过去7天内新发急性下腰痛的患者，并随访7天。包括神经阻滞给药在内的临床决策由医生自行决定。通过网络或纸质问卷收集患者报告的结果，并对接受神经阻滞注射的患者和未接受注射的患者进行比较。主要结局是疼痛残疾评估量表（PDAS）评分从基线到第3天的变化；次要结局包括第7天的PDAS变化和连续7天的视觉模拟量表（VAS）评分。使用多变量回归模型调整混杂因素。结果：共分析了567例患者（523例接受注射；44例未接受注射）。在基线PDAS评分≥45的患者中，接受注射的患者在第3天的改善更为显著。在基线评分为45时，PDAS评分的平均差异（95％置信区间（CI））为-6.42（-12.48至-0.36）（P = 0.038），在50时为-11.95（-21.35至-2.55）（P = 0.013），在55时为-17.54（-31.01至-4.07）（P = 0.011）。在第1天（平均差异（95%CI）：-0.70（-1.37至-0.04））和第3天（-
