Navigation Links
American Pain Society's low back guideline expanded to cover interventional procedures

TAMPA, May 10, 2008 - For low-back pain patients and their doctors, the American Pain Society,, said today it is expanding its evidence-based, clinical practice guideline on diagnosis and treatment of chronic low back pain to include recommendations on surgery and other interventional treatments. The expanded guideline was previewed today in a symposium at the APS Annual Scientific Meeting.

The second part of the APS guideline is based on a multidisciplinary panels review and analysis of volumes of evidence related to diagnosis and treatment of low-back pain with a number of interventional procedures and surgeries, according to Roger Chou, MD, director of the American Pain Societys Clinical Practice Guideline Program and associate professor of internal medicine, Oregon Health & Science University.

Chou noted that in addition to the multidisciplinary panel that formulated the guideline for evaluation and management of low back pain in primary care settings, additional experts with expertise on interventional therapies and surgeries for low back pain were recruited to review the evidence and formulate the expanded recommendations.

"Prior to finalizing the guideline, APS conducts extensive peer review, and has sent the guideline to more than 20 experts in surgery, interventional pain medicine, primary care, and other disciplines for comments and feedback," Chou said.

Low-back pain is the fifth most common reason for doctors office visits and one in four adults report having it last a least a day. Annually, low-back pain is estimated to account for more than $26 billion in direct health care costs in the U.S.

"The evidence is much better than even five or 10 years ago and both the primary care and interventional recommendations will help physicians be more confident when evaluating possible therapies for low back pain," said Chou. "As always, physicians and patients should discuss possible options proven by the evidence and choose the ones that make sense for their situation," he added.

During the symposium, Chou and two panel co-chairs, Richard Rosenquist, MD, assistant professor of anesthesiology, University of Iowa, and John Loeser, MD, professor, Department of Neurological Surgery, University of Washington, reported that for many interventional procedures the evidence from randomized controlled trials is mixed, sparse, not available or showed no benefits. Accordingly, the expanded, evidence-based APS guideline will report:

  • Invasive diagnostics, such as provocative discography, facet joint block and sacroliliac joint block tests, have not been proven to be accurate for diagnosing various spinal conditions, and their ability to effectively guide therapeutic choices and improve ultimate patient outcomes is uncertain.

  • Epidural stenois injections are an option for short-term pain relief for persistent radiculopathy (radiating low back pain caused by a herniated disc). Other interventional therapies, such as local injections, prolotherapy, botulinum toxin (botox) injection, facet joint injection, sacroliliac joint injection, radiofrequency denervation and intradiscal electrothermal therapy are not supported by convincing, consistent evidence of benefits from randomized trials.

  • Surgery to treat radiculopathy and spinal stenosis is effective, though the benefits diminish over time.

  • Effectiveness of surgery for non-radicular low back pain is less certain, with some studies showing no benefits compared to intensive interdisciplinary rehabilitation. In addition, a significant proportion of patients experience suboptimal outcomes including persistent pain or functional deficits following surgery.

    The expert panel reaffirms its previous recommendation that all low-back pain patients stay active and talk honestly with their physicians about self care and other interventions. "In general, non-invasive therapies supported by evidence showing benefits should be tried before considering interventional therapies or surgery," said Chou.

Recommendations from the first APS Clinical Practice Guideline on Low Back Pain were intended for primary care physicians and appeared in the Oct, 2, 2007 issue of the Annals of Internal Medicine. For diagnosis, the first APS low-back pain guideline advises clinicians to minimize routine use of x-rays or other diagnostic tests except for patients known or believed to have underlying neurological or spinal disorders.

In addressing treatment options, it recommended that medications used should be appropriate for the severity of baseline pain and functional impairment, and clinicians should weigh carefully potential benefits and risks of any drug and explain them. Also for various non-pharmacological treatments supported by the evidence, from spinal manipulation to massage therapy, the first guideline panel recommended they be considered for patients who do not improve with self-care options and prefer not to take pain medications.


Contact: Chuck Weber
American Pain Society

Related medicine news :

1. Many Older Americans Have Active Sex Lives
2. Despite grumbling, most Americans say they are happy at work
3. Record Number of Americans Lack Health Insurance
4. Longaberger Expands Horizon of Hope Campaign to Build Support for American Cancer Societys Breast Cancer Initiatives
5. AUDIO from Medialink and Pfizer: Number of Uninsured Americans Grows to 47 Million
6. New Survey Shows Americans are Still Concerned About Food Safety, Yet Still Not Smart About What They Like to Eat
7. Novo Nordisk Appoints New Leader of North American Business
8. Amid Improving Life Expectancy Rates, Risk of Premature Death is Still Significant for Americans, New Study Shows
9. Primary biliary cirrhosis more severe in African-American and Hispanic patients
10. AOA President Calls on Congress to Reauthorize SCHIP and Take Action to Ensure Health Care Coverage for All Americans
11. American Chemical Societys Weekly Presspac -- Sept. 5, 2007
Post Your Comments:
(Date:11/27/2015)... ... November 27, 2015 , ... Intellitec Solutions announced today that ... (MSDSLUG). Recognized as Microsoft’s official group for end users of Dynamics SL ERP ... partners, industry experts and representatives. Intellitec Solutions’ membership status demonstrates their ongoing commitment ...
(Date:11/27/2015)... , ... November 27, 2015 , ... ... Secura Consultants has prided itself for not only fulfilling the needs of advisers ... solutions at an affordable price and providing top-tier customer service. However, there's always ...
(Date:11/27/2015)... ... November 27, 2015 , ... CBD College is proud to ... Programs (CAAHEP) awarded accreditation to its Diagnostic Medical Sonography program. CBD College is honored ... one of twelve colleges and universities in the state of California make the cut. ...
(Date:11/27/2015)... ... November 27, 2015 , ... Dr. Thomas Dunlap and Dr. ... Tucker Bierbaum with Emergency Medicine at St., Joseph Health System’s Santa Rosa Memorial ... conditions present in similar ways and require time-critical intervention to avoid large area heart ...
(Date:11/27/2015)... ... November 27, 2015 , ... Indosoft ... announces the incorporation of Asterisk 11 LTS (Long Term Support) into its Q-Suite ... LTS brings Q-Suite 5.10 up-to-date with a version of Asterisk that will receive ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... Nov. 26, 2015 Research and Markets ( ... Cardiac Pacemaker Market Outlook to 2019 - Rise in Cardiac ... " report to their offering. ... Boston scientific and others. --> ... Medtronic, Biotronik, Boston scientific and others. ...
(Date:11/26/2015)... Research and Markets ( ) ... Future Horizons and Growth Strategies in the Japanese ... Segment Forecasts, Competitive Intelligence, Emerging Opportunities" report ... --> This new 247-page report ... drug monitoring market, including emerging tests, technologies, instrumentation, ...
(Date:11/26/2015)... DUBLIN , November 26, 2015 ... has announced the addition of the  ... in the Global Cell Surface Testing ... Opportunities" report to their offering.  ... the addition of the  "2016 Future ...
Breaking Medicine Technology: