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APS issues new guideline for low-back pain interventions, surgery
Date:5/13/2009

ent options," Chou explained. Shared decision making involves a patient's full participation in medical choices after receiving comprehensive information about the impact of all options on his or her particular life situation.

To develop the guideline, a multidisciplinary APS panel, augmented by experts on interventional therapies, reviewed 3,348 abstracts and analyzed 161 relevant clinical trials. The panel found that the evidence for the use of these interventions was mixed, sparse or not available. Based on the data the panel gathered, the APS now recommends:

  1. Against the use of provocative discography (injection of fluid into the disc in order to determine if it is the source of back pain) for patients with chronic nonradicular low-back pain.
  2. The consideration of intensive interdisciplinary rehabilitation with a cognitive/behavioral emphasis for patients with nonradicular low-back pain who do not respond to usual, non-interdisciplinary therapies.
  3. Against facet joint corticosteroid injection, prolotherapy, and intradiscal corticosteroid injections for patients with persistent nonradicular low-back pain, and insufficient evidence to guide use of other interventional therapies.
  4. A discussion of risks and benefits of surgery and the use of shared decision making with reference to rehabilitation as a similarly effective option for patients with nonradicular low-back pain, common degenerative spinal changes, and persistent and disabling symptoms.
  5. Insufficient evidence to guide recommendations for vertebral disc replacement.
  6. A discussion of the risks and benefits of epidural steroid injections and shared decision making, including specific review of evidence of lack of long-term benefit for patients with persistent radiculopathy due to herniated lumbar disc.
  7. A discussion of the risks and benefits of surgery and use of shared decision making that references moderate benefits that decrease over time for patients
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Contact: Tamara Hargens-Bradley
hargenst@ohsu.edu
503-494-8231
Oregon Health & Science University
Source:Eurekalert

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