TY - JOUR
T1 - Nonsurgical interventional therapies for low back pain
T2 - A review of the evidence for an American pain society clinical practice guideline
AU - Chou, Roger
AU - Atlas, Steven J.
AU - Stanos, Steven P.
AU - Rosenquist, Richard W.
PY - 2009/5/1
Y1 - 2009/5/1
N2 - 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.
AB - 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.
KW - Denervation
KW - Electrical stimulation therapy
KW - Electrocoagulation
KW - Epidural
KW - Injections
KW - Intervertebral disc
KW - Intervertebral disc chemolysis
KW - Low back pain
KW - Spinal
KW - Systematic review
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UR - http://www.scopus.com/inward/citedby.url?scp=67650322082&partnerID=8YFLogxK
U2 - 10.1097/BRS.0b013e3181a103b1
DO - 10.1097/BRS.0b013e3181a103b1
M3 - Review article
C2 - 19363456
AN - SCOPUS:67650322082
SN - 0362-2436
VL - 34
SP - 1078
EP - 1093
JO - Spine
JF - Spine
IS - 10
ER -