High-intensity signs in the epidural space are recognized on T2 weighted magnetic resonance images of patients with intractable low back pain. A case of percutaneous epidural adhesiolysis (PEA) with normal saline for intractable lower back pain have been reported. Lower back pain with numbness and neuropathic pain mimicked symptoms such as epidural adhesions. This type of pain might induce inflammatory granulation tissue formation within the epidural space. Hence, the patient underwent PEA with normal saline, which decreased intractable low back pain. PEA with normal saline may be useful for treating intractable low back pain with an epidural high-intensity sign.