Nonsurgical interventional therapies for low back pain: A review of the evidence for an American pain society clinical practice guideline

Roger Chou, Steven J. Atlas, Steven P. Stanos, Richard W. Rosenquist

Research output: Contribution to journalArticle

281 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1078-1093
Number of pages16
JournalSpine
Volume34
Issue number10
DOIs
StatePublished - May 1 2009

Fingerprint

Low Back Pain
Practice Guidelines
Pain
Injections
Intervertebral Disc Chemolysis
Steroids
Epidural Injections
Spinal Cord Stimulation
Zygapophyseal Joint
Radiculopathy
Electrocoagulation
Therapeutics
Failed Back Surgery Syndrome
Randomized Controlled Trials
Placebos
Databases
Sacroiliac Joint
Sciatica
Intervertebral Disc Displacement
Botulinum Toxins

Keywords

  • Denervation
  • Electrical stimulation therapy
  • Electrocoagulation
  • Epidural
  • Injections
  • Intervertebral disc
  • Intervertebral disc chemolysis
  • Low back pain
  • Spinal
  • Systematic review

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Nonsurgical interventional therapies for low back pain : A review of the evidence for an American pain society clinical practice guideline. / Chou, Roger; Atlas, Steven J.; Stanos, Steven P.; Rosenquist, Richard W.

In: Spine, Vol. 34, No. 10, 01.05.2009, p. 1078-1093.

Research output: Contribution to journalArticle

Chou, Roger ; Atlas, Steven J. ; Stanos, Steven P. ; Rosenquist, Richard W. / Nonsurgical interventional therapies for low back pain : A review of the evidence for an American pain society clinical practice guideline. In: Spine. 2009 ; Vol. 34, No. 10. pp. 1078-1093.
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abstract = "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.",
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KW - Systematic review

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