Clinical practice guidelines on interventional management of low back pain: A synthesis of recommendations

Olivier, Timothy J; Konda, Chaitanya; Pham, Tri Nhut; Nelson, Becky Baltich; Patel, Ankit; Sharma, Gauri; Trivedi, Kavita; Annaswamy, Thiru M.

doi:10.1002/pmrj.12930

Cited by 6 publications

(1 citation statement)

References 40 publications

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“…Lastly, of course, interventional and pharmacological treatment approaches for NSLBP can be personalized. However according to a recent systematic review (Olivier et al., 2022), for therapeutic reasons, the evidence for any interventional procedure (epidural steroid injections, radiofrequency procedures, facet injections, sacroiliac injections and prolotherapy) in the treatment of NSLBP (nota bene radiculopathy excluded) is inconclusive, even in clinical practice guidelines of high quality. The recommendation was highest for radiofrequency and facet procedures following a successful diagnostic block, emphasizing the advantage of trying to pinpoint the nociceptive source also in NSLBP.…”

Section: Personalized Management Of Nslbpmentioning

confidence: 99%

Personalized assessment and management of non‐specific low back pain

Wirth,

Schweinhardt

2023

European Journal of Pain

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Background and ObjectiveLow back pain (LBP), and in particular non‐specific low back pain (NSLBP), which accounts for approximately 90% of LBP, is the leading cause of years lived with disability worldwide. In clinical trials, LBP is often poorly categorized into ‘specific’ versus ‘non‐specific’ and ‘acute’ versus ‘chronic’ pain. However, a better understanding of the underlying pain mechanisms might improve study results and reduce the number of NSLBP patients.Databases and Data TreatmentNarrative review.ResultsNSLBP is a multi‐dimensional, biopsychosocial condition that requires all contributing dimensions to be assessed and prioritized. Thereby, the assessment of the contribution of nociceptive, neuropathic and nociplastic pain mechanisms forms the basis for personalized management. In addition, psychosocial (e.g. anxiety, catastrophizing) and contextual factors (e.g. work situation) as well as comorbidities need to be assessed and individually weighted. Personalized treatment of NSLBP further requires individually choosing treatment modalities, for example, exercising, patient education, cognitive‐behavioural advice, pharmacotherapy, as well as tailoring treatment within these modalities, for example, the delivery of tailored psychological interventions or exercise programs. As the main pain mechanism and psychosocial factors may vary over time, re‐assessment is necessary and treatment success should ideally be assessed quantitatively and qualitatively.ConclusionsThe identification of the main contributing pain mechanism and the integration of the patients' view on their condition, including beliefs, preferences, concerns and expectations, are key in the personalized clinical management of NSLBP. In research, particular importance should be placed on accurate characterization of patients and on including outcomes relevant to the individual patient.Significance StatementHere, a comprehensive review of the challenges associated with the diagnostic label ‘non‐specific low back pain’ is given. It outlines what is lacking in current treatment guidelines and it is summarized what is currently known with respect to individual phenotyping. It becomes clear that more research on clinically meaningful subgroups is needed to best tailor treatment approaches.

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Section: Personalized Management Of Nslbpmentioning

confidence: 99%

Personalized assessment and management of non‐specific low back pain

Wirth,

Schweinhardt

2023

European Journal of Pain

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Low‐value interventions to deimplement: A secondary analysis of a systematic review of low back pain clinical practice guidelines

Tai,

Kim,

Grover

et al. 2024

PM&R

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ObjectiveTo perform a secondary review of low back pain (LBP) clinical practice guidelines (CPG) identified in a recently conducted systematic review and to synthesize and summarize low‐value recommendations as practices that may be candidates for deimplementation.Literature SurveyLBP (subacute or chronic) CPGs in English (symptom based, created by a governmental or professional society, published between January 1990 and May 2020) were previously identified using MEDLINE, EMBASE, CINAHL, Ortho Guidelines, CPG Infobase, Emergency Care Research Institute, Guidelines International Network, National Institute of Health and Care Excellence, and Scottish Intercollegiate Guideline Network.MethodologyTwenty‐one CPGs were reviewed from a systematic review (previously published). Full‐text review of all 21 CPGs was conducted, and three recommendation categories indicative of low value (recommend strongly against, recommend weakly against, inconclusive/insufficient evidence) were identified using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) language and approach.SynthesisOne hundred thirty‐five low‐value recommendations were identified and classified under eight intervention categories: orthotics/support, traction, physical modalities, pharmacological interventions, injections, surgery, bed rest, and miscellaneous. Traction, transcutaneous electrical nerve stimulation (TENS), therapeutic ultrasound (TUS), and selective serotonin reuptake inhibitors (SSRI) had the most CPGs recommend strongly against their usage. Opioids were recommended strongly against by four CPGs. No significant difference (p > .05) was found between CPG quality and a specific deimplementation recommendation or between CPG quality and the number of strongly against, weakly against, and inconclusive/insufficient evidence recommendations.ConclusionsClinicians managing patients with chronic LBP should consider deimplementing these low‐value interventions (traction, TENS, TUS, and SSRI).

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Physical Activity Preferences of People Living with Brain Injury: Formative Qualitative Research to Develop a Discrete Choice Experiment

Haynes,

Howard,

Johnson

et al. 2023

Patient

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Background and Objective The World Health Organization physical activity guidelines for people living with disability do not consider the needs of people living with moderate-to-severe traumatic brain injury. This paper describes the qualitative co-development of a discrete choice experiment survey to inform the adaption of these guidelines by identifying the physical activity preferences of people living with moderate-to-severe traumatic brain injury in Australia. Methods The research team comprised researchers, people with lived experience of traumatic brain injury and health professionals with expertise in traumatic brain injury. We followed a four-stage process: (1) identification of key constructs and initial expression of attributes, (2) critique and refinement of attributes, (3) prioritisation of attributes and refinement of levels and (4) testing and refining language, format and comprehensibility. Data collection included deliberative dialogue, focus groups and think-aloud interviews with 22 purposively sampled people living with moderate-to-severe traumatic brain injury. Strategies were used to support inclusive participation. Analysis employed qualitative description and framework methods. Results This formative process resulted in discarding, merging, renaming and reconceptualising attributes and levels. Attributes were reduced from an initial list of 17 to six: (1) Type of activity, (2) Out-of-pocket cost, (3) Travel time, (4) Who with, (5) Facilitated by and (6) Accessibility of setting. Confusing terminology and cumbersome features of the survey instrument were also revised. Challenges included purposive recruitment, reducing diverse stakeholder views to a few attributes, finding the right language and navigating the complexity of discrete choice experiment scenarios. Conclusions This formative co-development process significantly improved the relevance and comprehensibility of the discrete choice experiment survey tool. This process may be applicable in other discrete choice experiment studies. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-023-00628-9.

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Clinical practice guidelines on interventional management of low back pain: A synthesis of recommendations

Cited by 6 publications

References 40 publications

Personalized assessment and management of non‐specific low back pain

Personalized assessment and management of non‐specific low back pain

Low‐value interventions to deimplement: A secondary analysis of a systematic review of low back pain clinical practice guidelines

Physical Activity Preferences of People Living with Brain Injury: Formative Qualitative Research to Develop a Discrete Choice Experiment

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