- 2003;6;3-81Evidence-Based Practice Guidelines for Interventional Techniques in the Management of Chronic Spinal Pain
Elmer E. Dunbar, MD, Sairam L. Atluri, MD, Cyrus E. Bakhit, MD, Leland Lou, MD,MPH, Standiford Helm, MD, Allen W. Burton, MD, Timothy R. Deer, MD, Gabor B. Racz, MD, Hans C. Hansen, MD, Thomas D. Falasca, DO, Andrea M. Trescot, MD, David S. Kloth, MD, Joseph F. Jasper, MD, Bradley D. Vilims, MD, David M. Schultz, MD, Vijay Singh, MD, Laxmaiah Manchikanti, MD, Peter S. Staats, MD, Aaron K. Calodney, MD, Samuel J. Hassenbusch, MD, and Claudio A. Feler, MD.
Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain are systematically developed and professionally derived statements and recommendations that assist both physicians and patients in making decisions about appropriate health care in the diagnosis and treatment of chronic or persistent pain.
The guidelines were developed utilizing an evidence-based approach to increase patient access to treatment, to improve outcomes and appropriateness of care, and to optimize cost-effectiveness. All types of relevant and published evidence and consensus were utilized. The guidelines include a discussion of their purpose, rationale, and importance, including descriptions of the patient population served, the methodology, and the pathophysiologic basis for intervention.
Multiple diagnostic and therapeutic interventional techniques are included in this document. Strong evidence was shown for diagnostic facet joint blocks for the diagnosis of facet joint pain, and lumbar provocative discography for discogenic pain. Moderate evidence was shown for sacroiliac joint blocks in the diagnosis of sacroiliac joint pain, and for transforaminal epidural injections in the preoperative evaluation of patients with negative or inconclusive imaging studies, but with clinical findings of nerve root irritation.
Moderate to strong evidence was shown for multiple therapeutic interventional techniques including medial branch blocks and medial branch neurotomy; caudal epidural steroid injections and transforaminal epidural steroid injections; lumbar percutaneous adhesiolysis; and implantable therapies.
These guidelines do not constitute inflexible treatment recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient’s medical condition, personal needs, and preferences, and the physician’s experience. Based on an individual patient’s needs, treatment different from that outlined here could be warranted. These guidelines do not represent “standard of care.”
Keywords: Interventional techniques, neural blockade, chronic pain, epidural injections, percutaneous epidural adhesiolysis, discography, facet joint pain, radiofrequency