International Panel recommends avoiding spinal injections for chronic pain

Today’s panel of international experts at BMJ should not be administered to adults with chronic low back pain, or to adults with chronic low back pain.

Their strong recommendations apply to procedures such as epidural steroid injections and nerve blocks in people living with chronic low back pain (for at least 3 months) that are not associated with cancer, infection, or inflammatory arthritis.

Their advice is based on the latest evidence and is part of BMJ’s “quick recommendation” initiative. This creates rapid and reliable guidance based on new evidence that will help physicians make better decisions with their patients.

Chronic lower back pain is a major cause of disorders around the world. It is estimated to affect one in five adults aged 20-59, with a higher proportion among older adults. In 2016, lower back and neck pain accounted for the highest medical costs in the United States at $134.5 billion.

Procedures such as epidural steroid injection, nerve blocking, and radio frequency ablation (using radio waves to destroy nerves) are widely used to stop pain signals reaching the brain, but now The guidelines provide conflicting recommendations.

Therefore, it consists of international panels of clinicians, people with chronic spinal pain, and research methodologists, and uses a grade approach (a system used to assess the quality of evidence) to provide the latest in the A detailed analysis of the evidence was conducted.

This evidence compared the benefits and harms of 13 common intervention procedures, or combinations of procedures, for chronic non-cancer spinal pain, for sham treatment, based on a review of randomized trials and observational studies.

After careful consideration, the panel concluded that there was no evidence of high certainty in the procedure and combination of procedures. Also, all low and moderate certainty evidence is due to spinal injections, such as axial pain (specific areas of the spine) or radicular pain (or radiated from the spine to the arm or leg). , compare it with fake procedures. Therefore, they are highly recommended for their use.

This includes injections of local anesthetics, steroids, or a combination of these. Epidural injection of local anesthetics, steroids, or a combination thereof. Radioactive stimulation with or without local anesthesia and steroid injection.

The panel added that these procedures are costly, burdensome to patients and have a small risk of harm. So almost all notified patients say they choose to avoid them.

Finally, they acknowledge that further research is guaranteed and may change future recommendations, particularly for procedures currently supported by evidence of low or very low certainty of validity. It’s there. Further research is also needed to establish the impact of intervention procedures on important patient outcomes such as opioid use, return to work, and sleep quality.

In a linked editorial, Jane Ballantine of the University of Washington, the question raised by this recommendation is whether it is reasonable to continue to provide these procedures to people with chronic back pain.

Changing established cultures is never easy, she writes, “However, if we can support the widespread use of these infusions, the evidence will result in more health care systems funding them.” It will be offering,” she wrote.

“This is not the last word on spinal injections for chronic low back pain, but chronic pain management is probably the best achieved by a better balance of refunds between procedural and non-durable chronic pain. There is a growing sense that there is a need for rethinking. Treatment,” she concluded.