1. 2025;28;E467-E479BMJ Publications on Interventional Techniques Do Not Meet Appropriateness Criteria of Conducting a Rapid Review: A Comprehensive Review
   Health Policy Review
   Laxmaiah Manchikanti, MD, Mahendra Sanapati, MD, Amol Soin, MD, Alan D. Kaye, MD, PhD, Alaa Abd-Elsayed, MD, Christopher G. Gharibo, MD, Allen Dennis, MD, and Joshua A. Hirsch, MD.

BACKGROUND: A recent surge of publications on interventional techniques has questioned their effectiveness, based on a rapid review and network meta-analysis of randomized trials. This was followed by releasing a clinical practice guideline recommending a global ban on these techniques. Understandably, such recommendations have raised significant concern worldwide. Interventional techniques are widely used in chronic pain management, yet their effectiveness has been debated, with longstanding concerns about overuse, misuse, fraud, and abuse.

OBJECTIVES: To provide a comprehensive review and critical analysis of the BMJ rapid reviews and associated guidelines, with particular attention to the application—or absence—of basic appropriateness criteria published in the same journal, and the improper incorporation of such evidence into guideline recommendations.

METHODS: A review of the available literature was conducted to assess the appropriate criteria for rapid reviews and guideline development.

RESULTS: The absence of established appropriateness criteria led to an inadequately conducted rapid review and poorly developed guidelines. These, in turn, resulted in sweeping, globally applicable recommendations that lack a sound evidentiary basis.

CONCLUSION: A thorough examination of BMJ publications and related literature demonstrates that the BMJ’s rapid reviews and subsequent guidelines on interventional techniques fail to meet recognized appropriateness criteria for conducting rapid reviews and developing consequential clinical guidelines based on such reviews.

KEY WORDS: Interventional techniques, low back pain, neck pain, lumbar radiculopathy, cervical radiculopathy, epidural injections, facet joint interventions, sacroiliac joint interventions