Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: An evidence-based clinical practice guideline from the American pain society

Roger Chou, John D. Loeser, Douglas K. Owens, Richard W. Rosenquist, Steven J. Atlas, Jamie Baisden, Eugene J. Carragee, Martin Grabois, Donald R. Murphy, Daniel K. Resnick, Steven P. Stanos, William O. Shaffer, Eric M. Wall

Research output: Contribution to journalArticle

358 Scopus citations

Abstract

STUDY DESIGN.: Clinical practice guideline. OBJECTIVE.: To develop evidence-based recommendations on use of interventional diagnostic tests and therapies, surgeries, and interdisciplinary rehabilitation for low back pain of any duration, with or without leg pain. SUMMARY OF BACKGROUND DATA.: Management of patients with persistent and disabling low back pain remains a clinical challenge. A number of interventional diagnostic tests and therapies and surgery are available and their use is increasing, but in some cases their utility remains uncertain or controversial. Interdisciplinary rehabilitation has also been proposed as a potentially effective noninvasive intervention for persistent and disabling low back pain. METHODS.: A multidisciplinary panel was convened by the American Pain Society. Its recommendations were based on a systematic review that focused on evidence from randomized controlled trials. Recommendations were graded using methods adapted from the US Preventive Services Task Force and the Grading of Recommendations, Assessment, Development, and Evaluation Working Group. RESULTS.: Investigators reviewed 3348 abstracts. A total of 161 randomized trials were deemed relevant to the recommendations in this guideline. The panel developed a total of 8 recommendations. CONCLUSION.: Recommendations on use of interventional diagnostic tests and therapies, surgery, and interdisciplinary rehabilitation are presented. Due to important trade-offs between potential benefits, harms, costs, and burdens of alternative therapies, shared decision-making is an important component of a number of the recommendations.

Original languageEnglish (US)
Pages (from-to)1066-1077
Number of pages12
JournalSpine
Volume34
Issue number10
DOIs
StatePublished - May 1 2009

Keywords

  • Botulinum toxin
  • Discectomy
  • Evidence-based
  • Fusion
  • Guideline
  • Injection
  • Interdisciplinary therapy
  • Intradiscal electrothermal therapy
  • Laminectomy
  • Low back pain
  • Multidisciplinary therapy
  • Radiofrequency denervation
  • Spinal cord stimulation
  • Surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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    Chou, R., Loeser, J. D., Owens, D. K., Rosenquist, R. W., Atlas, S. J., Baisden, J., Carragee, E. J., Grabois, M., Murphy, D. R., Resnick, D. K., Stanos, S. P., Shaffer, W. O., & Wall, E. M. (2009). Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: An evidence-based clinical practice guideline from the American pain society. Spine, 34(10), 1066-1077. https://doi.org/10.1097/BRS.0b013e3181a1390d