The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain

Abstract

Introduction Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety. Objective The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders. Methods The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented. Results After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain. Conclusion The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.

Mapping guideline‐informed care for chronic non‐specific low back pain with the biopsychosocial approach: A rapid review

“…The included guidelines were assessed for quality against the seven AGREE GRS criteria (Table 3). In relation to the "process of development," most (n = 9, 60%) guidelines were considered to be medium quality (scoring between 3 and 5 on a 7-point scale), 17,19,[24][25][26][27][28][29][30] with four (27%) guidelines rated as high quality (scoring 6 or 7) 18,20,21,23 and two rated as low quality (scoring 1 or 2). 22,31 For "presentation style," four guidelines were considered to be high quality, 17,20,23,25 three considered to be low quality, 22,26,31 and the remaining eight rated as medium qual ity.…”

“…22,31 For "presentation style," four guidelines were considered to be high quality, 17,20,23,25 three considered to be low quality, 22,26,31 and the remaining eight rated as medium qual ity. 18,19,21,24,[27][28][29][30] In terms of "completeness of reporting," eight guidelines were rated as medium quality, 18,19,21,24,26,[28][29][30] four T A B L E 1 Elements of each domain of the biopsychosocial approach that impact the management of CLBP. as high quality, 17,20,23,25 and three as low quality.…”

“…as high quality, 17,20,23,25 and three as low quality. 22,27,31 When assessed against the 'clinical validity' criterion, most included guidelines were rated as medium quality (n = 8), 18,19,24,[26][27][28][29][30] followed by high quality (n = 5), 17,20,21,23,25 and low quality (n = 2). 22,31 The 'overall quality' of included guidelines was rated as medium for nine guidelines, 18,19,21,24,[26][27][28][29][30] high for four guidelines, 17,20,23,25 and low for two guidelines.…”

“…22,27,31 When assessed against the 'clinical validity' criterion, most included guidelines were rated as medium quality (n = 8), 18,19,24,[26][27][28][29][30] followed by high quality (n = 5), 17,20,21,23,25 and low quality (n = 2). 22,31 The 'overall quality' of included guidelines was rated as medium for nine guidelines, 18,19,21,24,[26][27][28][29][30] high for four guidelines, 17,20,23,25 and low for two guidelines. 22,31 Scores for the last two criteria, "recommending the guideline" and "utilizing the guideline," were similarly rated (Table 3).…”

Nonsurgical Interventional Spine Pain Procedures

“…When used as a diagnostic block in cases of LBP, SI joint injections suggest a prevalence of SI originating joint pain of 10% to 26.6% with a false-positive rate of 20% to 22% 42-44 . The literature mentions therapeutic SI injections, but there are limited high-quality RCTs to support this use 45 .…”