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APS Issues New Guideline for Low-Back Pain Interventions, Surgery PORTLAND, Ore -- May 15, 2009 -- The American Pain Society (APS) has issued a new clinical practice guideline for low back pain that emphasises the use of noninvasive treatments over interventional procedures, as well as shared decision making between provider and patient. The findings are published in the May 1 issue of the journal Spine. The new APS guideline, based on an extensive review of existing research, provides clinicians with 8 recommendations to help determine the best way to treat patients with low-back pain. It also expands its current and previously published guideline for initial evaluation and management of this chronic condition. "These recommendations are based on an even more complete body of evidence than was available just a few years ago. Consequently, we believe these recommendations will give physicians more confidence when treating patients with persistent back pain," said lead author Roger Chou, MD, Oregon Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon. "Unfortunately, randomised trials for a number of commonly used interventional procedures are still too limited to generate evidence-based recommendations, and our review also highlights the need for more research," he added. To develop the guideline, a multidisciplinary APS panel, augmented by experts on interventional therapies, reviewed 3,348 abstracts and analysed 161 relevant clinical trials. The panel found that the evidence for the use of these interventions was mixed, sparse or not available. Based on the data the panel gathered, the APS now recommends: · Against the use of provocative discography for patients with chronic nonradicular low-back pain. · The consideration of intensive interdisciplinary rehabilitation with a cognitive/behavioural emphasis for patients with nonradicular low-back pain who do not respond to usual, non-interdisciplinary therapies. · Against facet joint corticosteroid injection, prolotherapy, and intradiscal corticosteroid injections for patients with persistent nonradicular low-back pain, and insufficient evidence to guide use of other interventional therapies. · A discussion of risks and benefits of surgery and the use of shared decision making with reference to rehabilitation as a similarly effective option for patients with nonradicular low-back pain, common degenerative spinal changes, and persistent and disabling symptoms. · Insufficient evidence to guide recommendations for vertebral disc replacement. · A discussion of the risks and benefits of epidural steroid injections and shared decision making, including specific review of evidence of lack of long-term benefit for patients with persistent radiculopathy due to herniated lumbar disc. · A discussion of the risks and benefits of surgery and use of shared decision making that references moderate benefits that decrease over time for patients with persistent and disabling radiculopathy due to herniated lumbar disc or persistent and disabling leg pain. · Discussion of risks and benefits of spinal cord stimulation and shared decision making, including reference to the high rate of complications following stimulator placement for patients with persistent and disabling radicular pain following surgery for herniated disc and no evidence of a persistently compressed nerve root. SOURCE: American Pain Society E-mail this page to a friend or colleague! To print, use this version