[Pain Management] Nonsurgical Interventional Therapies LBP: American Pain Society, Clinical Guideline

[Justin]

Spine. 34(10):1078-1093, May 1, 2009.

Nonsurgical Interventional Therapies for Low Back Pain: A Review of the Evidence for an American Pain Society Clinical Practice Guideline. [Review]

Chou, Roger MD *+; Atlas, Steven J. MD, MPH ++; Stanos, Steven P. DO [S]; Rosenquist, Richard W. MD [P]

From the Departments of *Medicine, and +Medical Informatics and Clinical Epidemiology, Oregon Evidence-Based Practice Center, Oregon Health and Science University, Portland, OR; ++Division of General Medicine, Medical Services, MA General Hospital, Harvard Medical School, Boston, MA; [S]Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL; and [P]Department of Anesthesiology, University of Iowa, Iowa City, IA.

Study Design. Systematic review.

Objective. To systematically assess benefits and harms of nonsurgical interventional therapies for low back and radicular pain.

Summary of Background Data. Although use of certain interventional therapies is common or increasing, there is also uncertainty or controversy about their efficacy.

Methods. Electronic database searches on Ovid MEDLINE and the Cochrane databases were conducted through July 2008 to identify randomized controlled trials and systematic reviews of local injections, botulinum toxin injection, prolotherapy, epidural steroid injection, facet joint injection, therapeutic medial branch block, sacroiliac joint injection, intradiscal steroid injection, chemonucleolysis, radiofrequency denervation, intradiscal electrothermal therapy, percutaneous intradiscal radiofrequency thermocoagulation, Coblation nucleoplasty, and spinal cord stimulation. All relevant studies were methodologically assessed by 2 independent reviewers using criteria developed by the Cochrane Back Review Group (for trials) and by Oxman (for systematic reviews). A qualitative synthesis of results was performed using methods adapted from the US Preventive Services Task Force.

Results. For sciatica or prolapsed lumbar disc with radiculopathy, we found good evidence that chemonucleolysis is moderately superior to placebo injection but inferior to surgery, and fair evidence that epidural steroid injection is moderately effective for short-term (but not long-term) symptom relief. We found fair evidence that spinal cord stimulation is moderately effective for failed back surgery syndrome with persistent radiculopathy, though device-related complications are common. We found good or fair evidence that prolotherapy, facet joint injection, intradiscal steroid injection, and percutaneous intradiscal radiofrequency thermocoagulation are not effective. Insufficient evidence exists to reliably evaluate other interventional therapies.

Conclusion. Few nonsurgical interventional therapies for low back pain have been shown to be effective in randomized, placebo-controlled trials.

(C) 2009 Lippincott Williams & Wilkins, Inc.

[yra]

Hey, I stumbled over here while looking for radiculopathy posts. Have any other radiculopathy books mentioned here?

[Justin]

Hey, I stumbled over here while looking for radiculopathy posts. Have any other radiculopathy books mentioned here?

Here are a couple recent posts about cervical radiculopathy found in the Education, Research and Spine Publications Forum here at SPS:

• Indications for Anterior Cervical Decompression for the Treatment of Cervical Degenerative Radiculopathy
  
• Cervical Laminoforaminotomy for the Treatment of Cervical Degenerative Radiculopathy
  
• Electrophysiological Monitoring during Surgery for Cervical Degenerative Myelopathy and Radiculopathy

Are you looking for cervical or lumbar radiculopathy resources?