Case: Multiple myeloma Male, 71 years old, diagnosed as lumbar disc herniation at the beginning, pain worsened after massage therapy, general condition deteriorated, pain department consultation was requested, and the bone marrow image was checked for abnormal plasma cells accounting for 80% of the bone marrow. Plasma globulin was elevated, and urine Benzoy protein was positive. MRI of lumbar spine showed diffuse and focal infiltration, sagittal T1-weighted image showed extensive hyposignalization of the vertebral body, and multiple nodular or patchy lower-signal shadows were seen in the low-signal background; Sagittal STIR image showed heterogeneous elevation of the vertebral body signals, and diagnosis was made as multiple-issue myeloma, which was transferred to hematology department for aggressive chemotherapy and supportive therapy. Bony lumbar spinal stenosis: there is the cauda equina compression ischemia manifestation, intermittent claudication, low back and leg pain, but the symptoms and signs are separated, and the diagnosis can be confirmed with the help of CT. In most of these cases, non-surgical treatment is feasible to relieve the symptoms, but in 20% of the cases, conservative treatment was ineffective, and orthopedic surgery was performed to enlarge the spinal canal, and the symptoms were relieved. True lumbar spondylolisthesis: Female, 45 years old, Korean, X-ray oblique radiographs and CT films showed lumbar isthmus fracture and 1 degree of lumbar spondylolisthesis with subluxation of lumbar intervertebral joints, and she was returned to Korea for surgical treatment. Lumbar disc herniation combined with bony spinal stenosis or calcification of the intervertebral disc or cauda equina syndrome. Treatment The cause and characteristics of the pain are treated with effective and safe treatments. 1. Determine the cause of the pain so that the appropriate treatment can be applied. Nerve block therapy is an effective measure for treating pain, and at the same time, it can break the vicious circle of disease development and provide conditions for curing the disease. However, practice has proved that there are still many cases, the analgesic effect of nerve block is not long-lasting, we must clarify the cause of the disease, to take the cause of the treatment, in order to fundamentally relieve the pain. (1) Acute infection caused by pain, must be active and effective anti-infection treatment, in order to completely and permanently relieve pain. Case 1: female, 52 years old, dengue. Case 2: Male, 46 years old, spondylitis. (2) Lumbar TB: had been misdiagnosed as lumbar disc herniation, came to our pain clinic, asked for history of low afternoon fever and night sweats. Laboratory tests: ESR 87mm/h. CT showed: L4.L5 vertebral body destruction. (3) myofascial pain syndrome (MFPS) limited range, clear pain point: short history of pain point injection of anti-inflammatory analgesic solution or laser therapy, long history of the disease and then added with needle knife therapy, are dispensed with NSAIDs. range of diffuse, the pain point is not clear: the use of traditional Chinese medicine vapor therapy, SSP, the range of the limited range of the pressure pain point after the detection of the pressure pain point, and then with injection and / or needle knife therapy. (4) Posterior spinal nerve compression syndrome (SPRCS): low back and leg pain beyond the knee, pressure pain at the projection of the outer border of the small joints, radiating to the buttocks or posterior femur can establish the diagnosis. It can be treated with block therapy, needle knife therapy, cryotherapy, **** therapy and so on. (5) Functional Joint Dysfunction Syndrome (FJDS): history of trauma, limitation of lumbar flexion to a fixed angle and worsening of pain, and percussion pain at the projection of the small joints. Intra-articular injection, decompression of the joint cavity by needle knife, and then manipulation. (6) Ankylosing spondylitis (AS): comprehensive treatment: feasible traditional Chinese medicine vapor therapy, needle knife release, manipulation, NSAIDs and special drugs (torch root, transfer factor, SASP, MTX) treatment and functional exercise. (7) Gout: acute exacerbation: colchicine, anti-inflammatory pain; non-exacerbation: reduce uric acid production drugs – allopurine + fast uric acid excretion drugs – probenecid 2. Analyze the characteristics of the pain and determine the location of the lesion. For lumbar and leg pain diseases that need to be treated with injectable drugs or needle and knife loosening, only the accurate localization of the lesion can ensure that the treatment is in place and receive the effect of needle to disease. (1) Lumbar disc herniation: first, according to the distribution area of the patient’s pain and physical signs to determine the spinal nerves involved, and then look for lesions along the spinal nerve pathway, which is in line with the pattern of a clear diagnosis and determine the location of the lesion. According to the X-ray film or CT film measurement and accurate positioning, puncture in place after the collagenase solution will be injected into the herniated disc, received a satisfactory dissolution of the disc effect. (2) Nerve root inflammation: Diagnosis, localization method and procedure are the same as disc herniation, except that the lesion found by CT is thickened nerve root, and the injected drugs are anti-inflammatory and analgesic drugs. (3) Nerve root adhesion: after dissolving disc surgery or nerve root inflammation lateral saphenous fossa injection, the pain disappeared or relieved, but about 60% of the patients still have soreness, numbness and other discomforts, and even nearly 20% of the patients still have radicular pain after getting out of bed. This is mostly due to nerve root compression or inflammation caused by edema, oozing, the surrounding fibrous tissue proliferation, caused by nerve root adhesion. In the past, it was more difficult to deal with. Now it is treated by needle knife loosening with internal or/and external foraminal orifice, which can receive immediate effect. Know the patient’s general condition to ensure the safety of treatment. In order to ensure satisfactory and safe treatment results, in order to clarify the cause of low back pain and lesion characteristics and location, but also must understand the patient’s general condition, important organ function, history of allergies, the planned treatment can withstand as well as possible adverse reactions, how to prevent and deal with, and so on. For patients with hypertension, coronary artery disease, diabetes mellitus, must be fully prepared for the needle, to be blood pressure, new function, blood sugar close to the normal range before the implementation of effective treatment methods. The treatment should be closely detected, and make all kinds of preparations for rescue. For patients with severe low back pain caused by severe radiculitis, the drug penetration reaction that may be caused by lateral saphenous injection must be fully estimated. We have encountered 7 cases of severe low back and leg pain in patients with high plane of block (up to T4) after 30 minutes of lateral saphenous fossa injection of anti-inflammatory and analgesic solution, with a drop in blood pressure, close observation, oxygen and accelerated infusion of fluids, and the blood pressure returned to normal within 10 minutes. All of these patients had smooth puncture, no cerebrospinal fluid on retraction, and obvious nerve root irritation reflex during rapid drug injection, i.e., severe radiating pain to the area of complaint. We analyzed that the permeability of the sheath membrane of the inflamed nerve root was increased, and that during high-pressure injection of anti-inflammatory and analgesic night, the drug could slowly penetrate into the subdural space and even the subarachnoid space. Therefore, now we stipulate that in cases of severe radiculitis, when injecting anti-inflammatory analgesic solution into the lateral saphenous fossa, we should first give a test volume for observation; secondly, the injection pressure should be small, and the injection speed should be slowed down; and thirdly, we should prolong the observation time after injection. Conclusion In conclusion, in the pain clinical face of low back pain patients, its etiology, condition and disease progression are different, only careful analysis, in order to correctly deal with, to obtain satisfactory clinical results.