It is known that, in spite of meeting appropriate clinical criteria for spinal cord stimulation (SCS) and having undergone flawless procedures, a significant number of patients who fail the therapy continues to exist. It is the purpose of this article to focus on the development of psychosocial indicators of success for SCS, if any. Referring to specialist literature authors present a review of what is known, what is not known, and what remains controversial on this topic. After reading this article we hope the reader will understand the importance of a psychological evaluation as part of the development of standards for identifying appropriate patients for this therapy. To improve treatment outcomes of SCS, seems to be essential to perform psychosocial evaluations on all persons clinically indicated for SCS to exclude those patients, who most probably, on a psychosocial level, will fail the procedure. To maximize treatment efficacy, authors believe spinal cord stimulation for chronic pain control must be part of a comprehensive program. An accurate preoperative psychosocial assessment and a course of psychological assistance both before and after therapy seems to be crucial for improving outcomes.

The aim of this prospective study was to evaluate the efficacy of endoscopic epidurolysis in the treatment of degenerative chronic low back pain.Two hundred and thirty four patients affected by chronic low back pain, with VAS ≥ 5 and Oswestry Low Back Pain Disability Index (ODI) from 0 to 60% (0-20%, group A; 20-40%, group B; 40-60%, group C) were enrolled and treated prospectively with endoscopic epidurolysis by means of a flexible fiberoptic endoscope introduced into the caudal epidural space and by the intermittent instillation of saline solution added with 150 UI hyaluronidase. Targeted application of ozone (8 ml; 38 γ/ml) and 50 mg ciprofloxacin close to the abnormal areas was also performed. Short and long term efficacy (1 week, 3 months, 6, 12, 24, 36 and 48 months) was prospectively evaluated. VAS score <5 and ODI <40% were considered as a positive outcome.The treatment significantly reduced VAS score in all three groups of patients starting from the first week and throughout the entire follow-up period (P < 0.001). Disability Index (ODI) too showed encouraging results (P < 0.001) that was particularly evident at 3 months and maintained up to long-term follow-up intervals.Epiduroscopy by mechanical adhesiolysis and administration on targeted areas of ciprofloxacin and ozone seems to be, in this prospective study, an effective technique to provide a sensible and persisting pain relief and act of improving ODI in chronic low back pain.

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It is well-known that morphine is the king of analgesics. It is widely used, and administered in various ways for the control of acute and chronic pain states. There are, however, certain types of pain and certain clinical conditions in which morphine cannot be used due to the risk of possible complications. These are usually pain states associated with intracranial hypertension, the presence of serious respiratory problems, the onset of major opioid tolerance, persistent vomiting, and so on. The search for "alternative analgesics" has been in progress for a decade, alternatives that could be used alone or in combination for spinal administration in the treatment of complex chronic pain states and with a low incidence of secondary effects. Today, research is carefully assessing the clinical effectiveness and the side effects of a series of drugs for spinal administration, that is, epidural or intrathecal, such as the new narcotics, alpha-2 agonists, central muscle relaxants, calcitonin, and local anesthetics. In this alternative analgesic category we have to mention the somatotrophin-release inhibiting factor (SRIF), which is an ubiquitous native hormone with widespread, predominantly inhibitory actions, and octreotide, its synthetic analogue. In this article we review the literature on the natural drug and its synthetic analogue, paying particular attention to the problems connected with intraspinal administration and analgesic properties.

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