Nonsurgical Interventional Therapies for Low Back Pain:
A Review of the Evidence for an American Pain Society
Clinical Practice Guideline

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   Spine (Phila Pa 1976). 2009 (May 1);   34 (10):   1078–1093

Chou, Roger MD; Atlas, Steven J. MD, MPH; Stanos,
Steven P. DO; Rosenquist, Richard W. MD

Department of Medicine,
Oregon Evidence-based Practice Center,
Oregon Health and Science University,
Portland, OR, USA.
chour@ohsu.edu

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Review the complete Guideline for the Evaluation and Management of Low Back Pain: Evidence Review (482 page Adobe Acrobat file)

STUDY DESIGN:   Systematic review.

OBJECTIVE:   To systematically assess benefits and harms of nonsurgical interventional therapies for low back and radicular pain.

SUMMARY OF BACKGROUND DATA:   Although use of certain interventional therapies is common or increasing, there is also uncertainty or controversy about their efficacy.

METHODS:   Electronic database searches on Ovid MEDLINE and the Cochrane databases were conducted through July 2008 to identify randomized controlled trials and systematic reviews of local injections, botulinum toxin injection, prolotherapy, epidural steroid injection, facet joint injection, therapeutic medial branch block, sacroiliac joint injection, intradiscal steroid injection, chemonucleolysis, radiofrequency denervation, intradiscal electrothermal therapy, percutaneous intradiscal radiofrequency thermocoagulation, Coblation nucleoplasty, and spinal cord stimulation. All relevant studies were methodologically assessed by 2 independent reviewers using criteria developed by the Cochrane Back Review Group (for trials) and by Oxman (for systematic reviews). A qualitative synthesis of results was performed using methods adapted from the US Preventive Services Task Force.

RESULTS:   For sciatica or prolapsed lumbar disc with radiculopathy, we found good evidence that chemonucleolysis is moderately superior to placebo injection but inferior to surgery, and fair evidence that epidural steroid injection is moderately effective for short-term (but not long-term) symptom relief. We found fair evidence that spinal cord stimulation is moderately effective for failed back surgery syndrome with persistent radiculopathy, though device-related complications are common. We found good or fair evidence that prolotherapy, facet joint injection, intradiscal steroid injection, and percutaneous intradiscal radiofrequency thermocoagulation are not effective. Insufficient evidence exists to reliably evaluate other interventional therapies.

CONCLUSION:   Few nonsurgical interventional therapies for low back pain have been shown to be effective in randomized, placebo-controlled trials.

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