Comprehensive Review of Therapeutic Interventions in Managing Chronic Spinal Pain

Abstract

Background: Available evidence documents a wide degree of variance in the definition and practice of interventional pain management. Objective: To provide evidence-based clinical practice guidelines for interventional techniques in the treatment of chronic spinal pain. Design: Best evidence synthesis. Methods: Strength of evidence was assessed by the U.S. Preventive Services Task Force (USPSTF) criteria utilizing 5 levels of evidence ranging from Level I to III with 3 subcategories in Level II. Outcomes: Short-term pain relief was defined as relief lasting 6 months or less and long-term relief as longer than 6 months, except ≤ one year and > one year for intradiscal therapies, mechanical disc decompression, spinal cord stimulation, and intrathecal infusion systems. Results: The indicated evidence for therapeutic interventions is Level I for caudal epidural steroid injections in managing disc herniation or radiculitis, and discogenic pain without disc herniation or radiculitis. The evidence is Level I to II-1 for percutaneous adhesiolysis in management of pain secondary to post-lumbar surgery syndrome. The evidence is Level II-1 or II-2 for therapeutic cervical, thoracic, and lumbar facet joint nerve blocks; for caudal epidural injections in managing pain of post-lumbar surgery syndrome, and lumbar spinal stenosis, for cervical interlaminar epidural injections in managing cervical pain (Level II-1); for lumbar transforaminal epidural injections; and spinal cord stimulation for post-lumbar surgery syndrome. Limitations: The limitations of this guideline preparation included a paucity of literature, lack of updates, and lack of conflicts in preparation of systematic reviews and guidelines by various organizations. Conclusion: The indicated evidence for therapeutic interventions is variable from Level I to III. This comprehensive review includes the evaluation of evidence for therapeutic procedures in managing chronic spinal pain and recommendations. However, this review and recommendations do not constitute inflexible treatment recommendations or “standard of care.” Key words: Interventional techniques, chronic spinal pain, therapeutic interventions, facet joint interventions, epidural procedures, epidural adhesiolysis, radiofrequency, mechanical disc decompression, spinal cord stimulation, intrathecal implantable systems

Dextrose injections for failed back surgery syndrome: a consecutive case series

“…Some studies mentioned that these methods have advantages over revision surgeries [28][29][30]. Epidural steroid, hyaluronidase or local anesthetic injections are increasingly being used because of their simplicity and cheapness; however, there is limited evidence about them and some other studies declared that these injections do not present better clinical outcomes than percutaneous adhesiolysis [31][32][33]. Revision surgeries had been the most common used method with the rates ranging from 5 to 33% in the past [34].…”

Spezifische und nicht spezifische Rückenschmerzen

“…In Ergänzung zur Anamnese und klinischen Untersuchung wird in der klinischen Praxis generell akzeptiert, dass diagnostische Facettenblockaden eine zuverlässige bzw. die zuverlässigste Methode zum Nachweis eines Facettensyndroms sind [15][16][17][18].…”

“…epidurale oder intradiscale Injektionen sowie perkutane Nukleoplastie Verfahren, sind in der Literatur beschrieben worden und sind möglicher Bestandteil der Therapie. Unklar bleibt ob neben einem möglichen kurzfristigen Effekt auch ein langfristiger positiver Effekt erzielt werden kann [17,18,[39][40][41][42][43].…”

Protocol for Evaluation of the Comparative Effectiveness of Percutaneous Adhesiolysis and Caudal Epidural Steroid Injections in Low Back and/or Lower Extremity Pain without Post Surgery Syndrome or Spinal Stenosis

“…The underlying mechanism of action of epidurally administered steroid and local anesthetic injections is still not well understood. It is believed that the achieved neural blockade alters or interrupts nociceptive input, reflex mechanism of the afferent fibers, self-sustaining activity of the neurons, and the pattern of central neuronal activities (5,21,68,96,97). Further, corticosteroids have been shown to reduce inflammation by inhibiting either the synthesis or release of a number of pro-inflammatory mediators and by causing a reversible local anesthetic effect (97)(98)(99)(100)(101)(102)(103)(104)(105).…”