Letters

Manchikanti, Laxmaiah; Jasper, Joseph F.; Singh, Sanjiv

doi:10.1097/00007632-200112010-00031

Cited by 7 publications

(3 citation statements)

References 19 publications

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“…Yet, therapies may be of real value even if unproven in the literature. 65,66 Second, a large number of poorly constructed studies present in the literature support the use of therapies that may not have value, lessening monies available for therapies that do help patients in pain. As Loeser 67 notes, "An often unrecognized peril of the pursuit of cure is that too much of the available health care dollar is spent on useless diagnostic tests and treatment, including surgery, that do not achieve useful outcomes for the patient or the payor.…”

Section: The Limitations Of Clinical Guidelinesmentioning

confidence: 99%

Hoffman's glasses: evidence-based medicine and the search for quality in the literature of interventional pain medicine

Merrill

2003

Regional Anesthesia and Pain Medicine

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Section: The Limitations Of Clinical Guidelinesmentioning

confidence: 99%

Hoffman's glasses: evidence-based medicine and the search for quality in the literature of interventional pain medicine

Merrill

2003

Regional Anesthesia and Pain Medicine

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“…Among the 7 randomized trials included in the evidence synthesis meeting inclusion criteria, 6 of them evaluated effectiveness in lumbar disc herniation and radiculopathy (950,952,955,956,95,961), showing positive results in 4 of the 6, both in short-term and long-term with 2 negative studies (951,95). The seventh trial (953) studied effectiveness in post surgery syndrome and yielded negative results.…”

Section: Studymentioning

confidence: 99%

Interventional Techniques: Evidence-based Practice Guidelines in the Management of Chronic Spinal Pain

Asipp¹

2007

Pain Phys

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Background: The evidence-based practice guidelines for the management of chronic spinal pain with interventional techniques were developed to provide recommendations to clinicians in the United States. Objective: To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic spinal pain, utilizing all types of evidence and to apply an evidence-based approach, with broad representation by specialists from academic and clinical practices. Design: Study design consisted of formulation of essentials of guidelines and a series of potential evidence linkages representing conclusions and statements about relationships between clinical interventions and outcomes. Methods: The elements of the guideline preparation process included literature searches, literature synthesis, systematic review, consensus evaluation, open forum presentation, and blinded peer review. Methodologic quality evaluation criteria utilized included the Agency for Healthcare Research and Quality (AHRQ) criteria, Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria, and Cochrane review criteria. The designation of levels of evidence was from Level I (conclusive), Level II (strong), Level III (moderate), Level IV (limited), to Level V (indeterminate). Results: Among the diagnostic interventions, the accuracy of facet joint nerve blocks is strong in the diagnosis of lumbar and cervical facet joint pain, whereas, it is moderate in the diagnosis of thoracic facet joint pain. The evidence is strong for lumbar discography, whereas, the evidence is limited for cervical and thoracic discography. The evidence for transforaminal epidural injections or selective nerve root blocks in the preoperative evaluation of patients with negative or inconclusive imaging studies is moderate. The evidence for diagnostic sacroiliac joint injections is limited. The evidence for therapeutic lumbar intraarticular facet injections is moderate for short-term and long-term improvement, whereas, it is limited for cervical facet joint injections. The evidence for lumbar and cervical medial branch blocks is moderate. The evidence for medial branch neurotomy is moderate. The evidence for caudal epidural steroid injections is strong for short-term relief and moderate for long-term relief in managing chronic low back and radicular pain, and limited in managing pain of postlumbar laminectomy syndrome. The evidence for interlaminar epidural steroid injections is strong for short-term relief and limited for long-term relief in managing lumbar radiculopathy, whereas, for cervical radiculopathy the evidence is moderate. The evidence for transforaminal epidural steroid injections is strong for short-term and moderate for long-term improvement in managing lumbar nerve root pain, whereas, it is moderate for cervical nerve root pain and limited in managing pain secondary to lumbar post laminectomy syndrome and spinal stenosis. The evidence for percutaneous epidural adhesiolysis is strong. For spinal endoscopic adhesiolysis, the evidence is strong for short-term relief and moderate for long-term relief. For sacroiliac intraarticular injections, the evidence is limited. The evidence for radiofrequency neurotomy for sacroiliac joint pain is limited. The evidence for intradiscal electrothermal therapy is moderate in managing chronic discogenic low back pain, whereas for annuloplasty the evidence is limited. Among the various techniques utilized for percutaneous disc decompression, the evidence is moderate for short-term and limited for long-term relief for automated percutaneous lumbar discectomy, and percutaneous laser discectomy, whereas it is limited for nucleoplasty and for DeKompressor technology. For vertebral augmentation procedures, the evidence is moderate for both vertebroplasty and kyphoplasty. The evidence for spinal cord stimulation in failed back surgery syndrome and complex regional pain syndrome is strong for shortterm relief and moderate for long-term relief. The evidence for implantable intrathecal infusion systems is strong for short-term relief and moderate for long-term relief. Conclusion: These guidelines include the evaluation of evidence for diagnostic and therapeutic procedures in managing chronic spinal pain and recommendations for managing spinal pain. However, these guidelines do not constitute inflexible treatment recommendations. These guidelines also do not represent a “standard of care.” Key words: Interventional techniques, chronic spinal pain, diagnostic blocks, therapeutic interventions, facet joint interventions, epidural injections, epidural adhesiolysis, discography, radiofrequency, disc decompression, vertebroplasty, kyphoplasty, spinal cord stimulation, intrathecal implantable systems

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“…Conflicting results have been reported by intraarticular injections of facet joints (50)(51)(52)(53)(54), medial branch blocks (53)(54)(55) and radiofrequency neurotomy of medial branches (56)(57)(58)(59)(60)(61). Multiple systematic and narrative reviews also have yielded mixed results (1,(62)(63)(64)(65)(66)(67).…”

mentioning

confidence: 99%

Medial Branch Neurotomy in Management of Chronic Spinal Pain: Systematic Review of the Evidence

Manchikanti

Singh²,

Bd³

et al. 2002

Pain Phys

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Letters

Cited by 7 publications

References 19 publications

Hoffman's glasses: evidence-based medicine and the search for quality in the literature of interventional pain medicine

Hoffman's glasses: evidence-based medicine and the search for quality in the literature of interventional pain medicine

Interventional Techniques: Evidence-based Practice Guidelines in the Management of Chronic Spinal Pain

Medial Branch Neurotomy in Management of Chronic Spinal Pain: Systematic Review of the Evidence

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