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

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

doi:10.1097/brs.0b013e3181a103b1

Cited by 392Spine and Intervertebral Disc PathologyMusculoskeletal pain and rehabilitationPain Management and Treatment

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

Chou, Roger, Atlas, Steven J., Stanos, Steven P., Rosenquist, Richard W.·2009·Spine

DOI 10.1097/brs.0b013e3181a103b1

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Abstract

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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Many interventions for chronic low back pain produce some clinical benefit, but few consistently yield substantial long-term pain reduction with improved function.
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RELIEVING PAIN IN AMERICA: A BLUEPRINT FOR TRANSFORMING PREVENTION, CARE, EDUCATION, AND RESEARCH
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Treatment of chronic non-cancer pain
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Interventional Therapies, Surgery, and Interdisciplinary Rehabilitation for Low Back Pain: An Evidence-Based Clinical Practice Guideline From the American Pain Society
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Self-citation
Report of the NIH Task Force on research standards for chronic low back pain.
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Lumbar Spinal Stenosis
Genevay, S., & Atlas, S. J. (2010) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2009.11.001 · Cited by 394 · see citing works
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Intervertebral Disc Diseases PART 2: A Review of the Current Diagnostic and Treatment Strategies for Intervertebral Disc Disease
Wu, P. H., Kim, H. S., & Jang, I. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21062135 · Cited by 269 · see citing works
Epidural Corticosteroid Injections in the Management of Sciatica
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Efficacy and safety of tanezumab in the treatment of chronic low back pain
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Guidelines Warfare Over Interventional Techniques: Is There a Lack of Discourse or Straw Man?
Manchikanti, L. (2012) · Pain Physician · doi:10.36076/ppj.2012/15/e1 · Cited by 237 · see citing works
Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain
Paige, N. M., Miake-Lye, I. M., Booth, M. S., Beroes, J. M., Mardian, A. S., Dougherty, P. E., Branson, R., Tang, B., Morton, S. C., & Shekelle, P. (2017) · JAMA · doi:10.1001/jama.2017.3086 · Cited by 245 · see citing works
Facet joint pain—advances in patient selection and treatment
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Report of the NIH Task Force on Research Standards for Chronic Low Back Pain
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Self-citation
Pathophysiology, diagnosis, and treatment of discogenic low back pain
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Comparative Effectiveness of Lumbar Transforaminal Epidural Steroid Injections with Particulate Versus Nonparticulate Corticosteroids for Lumbar Radicular Pain due to Intervertebral Disc Herniation: A Prospective, Randomized, Double-Blind Trial
Kennedy, D. J. “. J. ”., Plastaras, C. T., CASEY, E. K., Visco, C. J., Rittenberg, J., Conrad, B. P., Sigler, J. D., & Dreyfuss, P. H. (2014) · Pain Medicine · doi:10.1111/pme.12325 · Cited by 200 · see citing works
Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis
Chou, R., Hashimoto, R. E., Friedly, J. L., Fu, R. F., Bougatsos, C., Dana, T., Sullivan, S. D., & Jarvik, J. G. (2015) · Annals of Internal Medicine · doi:10.7326/m15-0934 · Cited by 200 · see citing works
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Evaluation of Lumbar Facet Joint Nerve Blocks in Managing Chronic Low Back Pain: A Randomized, Double-Blind, Controlled Trial with a 2-Year Follow-Up
Manchikanti, L., Singh, V. P., Falco, F. J. E., Cash, K. A., & Pampati, V. (2010) · International Journal of Medical Sciences · doi:10.7150/ijms.7.124 · Cited by 195 · see citing works
11. Lumbosacral Radicular Pain
Boxem, K. V., Cheng, J., Patijn, J., van Kleef, M., Lataster, A., Mekhail, N. A., & Zundert, J. H. M. V. (2010) · Pain Practice · doi:10.1111/j.1533-2500.2010.00370.x · Cited by 194 · see citing works
Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines
O'Connell, N. E., Cook, C. E., Wand, B. M., & Ward, S. P. (2016) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2017.05.001 · Cited by 193 · see citing works
Report of the NIH Task Force on Research Standards for Chronic Low Back Pain
Deyo, R. A., Dworkin, S. F., Amtmann, D., Andersson, G. B. J., BORENSTEIN, D. G., Carragee, E. J., Carrino, J. A., Chou, R., Cook, K. F., Delitto, A., et al. (2014) · Spine · doi:10.1097/brs.0000000000000434 · Cited by 184 · see citing works
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Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain.
Manchikanti, L., Buenaventura, R. M., Manchikanti, K. N., Ruan, X., Gupta, S., Smith, H. S., Christo, P. J., & Ward, S. P. (2012) · PubMed · Cited by 173 · see citing works
Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature
Kim, H. S., Wu, P. H., & Jang, I. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21041483 · Cited by 174 · see citing works
Incidence and Characteristics of Complications from Epidural Steroid Injections
McGrath, J. M., Schaefer, M. P., & Malkamaki, D. M. (2011) · Pain Medicine · doi:10.1111/j.1526-4637.2011.01077.x · Cited by 165 · see citing works
Evaluation of the Effectiveness of Lumbar Interlaminar Epidural Injections in Managing Chronic Pain of Lumbar Disc Herniation or Radiculitis: A Randomized, Double-Blind, Controlled Trial
Manchikanti, L. (2010) · Pain Physician · doi:10.36076/ppj.2010/13/343 · Cited by 162 · see citing works
12. Pain Originating from the Lumbar Facet Joints
van Kleef, M., Vanelderen, P., Cohen, S. P., Lataster, A., Zundert, J. H. M. V., & Mekhail, N. A. (2010) · Pain Practice · doi:10.1111/j.1533-2500.2010.00393.x · Cited by 159 · see citing works
Low Back Pain and Lumbar Spine Osteoarthritis: How Are They Related?
Goode, A. P., Carey, T. S., & Jordan, J. M. (2013) · Current Rheumatology Reports · doi:10.1007/s11926-012-0305-z · Cited by 158 · see citing works
Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses
Lewis, R. A., Williams, N. H., Sutton, A. J., Burton, K. A., Din, N., Matar, H. E., Hendry, M., Phillips, C. J., Nafees, S. B., Fitzsimmons, D. F., et al. (2013) · The Spine Journal · doi:10.1016/j.spinee.2013.08.049 · Cited by 157 · see citing works
Do Epidural Injections Provide Short- and Long-term Relief for Lumbar Disc Herniation? A Systematic Review
Manchikanti, L., Benyamin, R. M., Falco, F. J. E., Kaye, A. D., & Hirsch, J. A. (2014) · Clinical Orthopaedics and Related Research · doi:10.1007/s11999-014-3490-4 · Cited by 152 · see citing works
Low Back Pain
Chou, R. (2021) · Annals of Internal Medicine · doi:10.7326/aitc202108170 · Cited by 159 · see citing works
Self-citation
Report of the NIH Task Force on Research Standards for Chronic Low Back Pain
Deyo, R. A., Dworkin, S. F., Amtmann, D., Andersson, G., Borenstein, D., Carragee, E. J., Carrino, J., Chou, R., Cook, K., DeLitto, A., et al. (2014) · The Spine Journal · doi:10.1016/j.spinee.2014.05.002 · Cited by 149 · see citing works
Self-citation
Patient Protection and Affordable Care Act of 2010: Reforming the Health Care Reform for the New Decade
Manchikanti, L. (2011) · Pain Physician · doi:10.36076/ppj.2011/14/e35 · Cited by 145 · see citing works
Neuroimaging-based biomarkers for pain: state of the field and current directions
van der Miesen, M. M., Lindquist, M. A., & Wager, T. D. (2019) · PAIN Reports · doi:10.1097/pr9.0000000000000751 · Cited by 137 · see citing works
Injury and Liability Associated with Cervical Procedures for Chronic Pain
Rathmell, J. P., Michna, E., Fitzgibbon, D. R., Stephens, L. S., Posner, K. L., & Domino, K. B. (2011) · Anesthesiology · doi:10.1097/aln.0b013e31820fc7f2 · Cited by 140 · see citing works
Ageism, negative attitudes, and competing co-morbidities – why older adults may not seek care for restricting back pain: a qualitative study
Makris, U. E., Higashi, R. T., Marks, E. G., Fraenkel, L., Sale, J. E. M., Gill, T. M., & Reid, M. C. (2015) · BMC Geriatrics · doi:10.1186/s12877-015-0042-z · Cited by 131 · see citing works
Report of the NIH Task Force on Research Standards for Chronic Low Back Pain
Deyo, R. A., Dworkin, S. F., Amtmann, D., Andersson, G. B. J., BORENSTEIN, D. G., Carragee, E. J., Carrino, J. A., Chou, R., Cook, K. F., Delitto, A., et al. (2014) · Pain Medicine · doi:10.1111/pme.12538 · Cited by 130 · see citing works
Self-citation
Epidural Steroids, Etanercept, or Saline in Subacute Sciatica
Cohen, S. P., White, R. L., Kurihara, C., Larkin, T. M., Chang, A., Griffith, S. R., Gilligan, C. J., Larkin, R., Morlando, B., Pasquina, P. F., et al. (2012) · Annals of Internal Medicine · doi:10.7326/0003-4819-156-8-201204170-00397 · Cited by 127 · see citing works
A Randomized, Controlled, Double-Blind Trial of Fluoroscopic Caudal Epidural Injections in the Treatment of Lumbar Disc Herniation and Radiculitis
Manchikanti, L., Singh, V. P., Cash, K. A., Pampati, V., Damron, K. S., & Boswell, M. V. (2011) · Spine · doi:10.1097/brs.0b013e31823294f2 · Cited by 125 · see citing works
Prevention and management of chronic back pain
Weiner, S. S., & Nordin, M. (2010) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2009.12.001 · Cited by 119 · see citing works
A Narrative Review of Lumbar Medial Branch Neurotomy for the Treatment of Back Pain
Bogduk, N., Dreyfuss, P. H., & Govind, J. (2009) · Pain Medicine · doi:10.1111/j.1526-4637.2009.00692.x · Cited by 119 · see citing works
Epidural Injections for Spinal Pain
Bicket, M. C., Gupta, A., Brown, C. H., & Cohen, S. P. (2013) · Anesthesiology · doi:10.1097/aln.0b013e31829c2ddd · Cited by 116 · see citing works
The Effectiveness and Risks of Fluoroscopically Guided Lumbar Interlaminar Epidural Steroid Injections: A Systematic Review with Comprehensive Analysis of the Published Data
Sharma, A. K., Vorobeychik, Y., Wasserman, R. A., Jameson, J. B., Moradian, M., Duszynski, B. S., Kennedy, D. J. “. J. ”., & on behalf of the Standards Division of the Spine Intervention Society (2016) · Pain Medicine · doi:10.1093/pm/pnw131 · Cited by 118 · see citing works
Lumbar Spine MRI for Low Back Pain: Indications and Yield
Roudsari, B. S., & Jarvik, J. G. (2010) · American Journal of Roentgenology · doi:10.2214/ajr.10.4367 · Cited by 112 · see citing works
Facts, Fallacies, and Politics of Comparative Effectiveness Research: Part I. Basic Considerations
Manchikanti, L. (2010) · Pain Physician · doi:10.36076/ppj.2010/13/e23 · Cited by 111 · see citing works
Low back pain
Golob, A. L., & Wipf, J. E. (2014) · Medical Clinics of North America · doi:10.1016/j.mcna.2014.01.003 · Cited by 109 · see citing works
Chronic low back pain: pharmacological, interventional and surgical strategies
Morlion, B. J. (2013) · Nature Reviews Neurology · doi:10.1038/nrneurol.2013.130 · Cited by 108 · see citing works
Defining Patient Complexity
Cerimele, J. M., & Peccoralo, L. A. (2012) · Annals of Internal Medicine · doi:10.7326/0003-4819-156-8-201204170-00002 · Cited by 100 · see citing works
Spine-area pain in military personnel: a review of epidemiology, etiology, diagnosis, and treatment
Cohen, S. P., Gallagher, R. M., Davis, S. A., Griffith, S. R., & Carragee, E. J. (2011) · The Spine Journal · doi:10.1016/j.spinee.2011.10.010 · Cited by 100 · see citing works
Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety
Benoist, M., Boulu, P., & Hayem, G. (2011) · European Spine Journal · doi:10.1007/s00586-011-2007-z · Cited by 97 · see citing works
Epidural Steroid Injections, Conservative Treatment, or Combination Treatment for Cervical Radicular Pain
Cohen, S. P., Hayek, S. M., Semenov, Y. R., Pasquina, P. F., White, R. L., Veizi, E., Huang, J. H. Y., Kurihara, C., Zhao, Z., Guthmiller, K. B., et al. (2014) · Anesthesiology · doi:10.1097/aln.0000000000000409 · Cited by 97 · see citing works
Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of low back pain: a randomized controlled trial.
Fiore, P., Panza, F., Cassatella, G., Russo, A., Frisardi, V., Solfrizzi, V., Ranieri, M., Teo, L. D., & Santamato, A. (2011) · PubMed · Cited by 97 · see citing works
Systematic Review of the Effectiveness of Lumbar Medial Branch Thermal Radiofrequency Neurotomy, Stratified for Diagnostic Methods and Procedural Technique
Schneider, B. J., Doan, L., Maes, M. K., Martinez, K. R., Cota, A. G., Bogduk, N., & on behalf of the Standards Division of the Spine Intervention Society (2019) · Pain Medicine · doi:10.1093/pm/pnz349 · Cited by 93 · see citing works
Patients' perceived needs of health care providers for low back pain management: a systematic scoping review
Chou, L., Ranger, T. A., Peiris, W. L., Cicuttini, F., Urquhart, D. M., Sullivan, K., Seneviwickrama, M., Briggs, A. M., & Wluka, A. E. (2018) · The Spine Journal · doi:10.1016/j.spinee.2018.01.006 · Cited by 91 · see citing works
Initial Management Decisions After a New Consultation for Low Back Pain: Implications of the Usage of Physical Therapy for Subsequent Health Care Costs and Utilization
Fritz, J. M., Brennan, G. P., Hunter, S. J., & Magel, J. S. (2013) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2013.01.008 · Cited by 90 · see citing works
Growth of Spinal Interventional Pain Management Techniques
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Exercise-induced FNDC5/irisin protects nucleus pulposus cells against senescence and apoptosis by activating autophagy
Zhou, W., Shi, Y., Wang, H., Chen, L., Yu, C., Zhang, X., Yang, L., Zhang, X., & Wu, A. (2022) · Experimental & Molecular Medicine · doi:10.1038/s12276-022-00811-2 · Cited by 87 · see citing works
An Update of the Systematic Assessment of the Diagnostic Accuracy of Lumbar Facet Joint Nerve Blocks
Falco, F. J. E. (2012) · Pain Physician · doi:10.36076/ppj.2012/15/e869 · Cited by 85 · see citing works
Management of Degenerative Disk Disease and Chronic Low Back Pain
Karppinen, J. I., Shen, F. H., Luk, K. D. K., Andersson, G. B. J., Cheung, K., & Samartzis, D. (2011) · Orthopedic Clinics of North America · doi:10.1016/j.ocl.2011.07.009 · Cited by 84 · see citing works
Focus article: report of the NIH task force on research standards for chronic low back pain
Deyo, R. A., Dworkin, S. F., Amtmann, D., Andersson, G. B. J., BORENSTEIN, D. G., Carragee, E. J., Carrino, J. A., Chou, R., Cook, K. F., Delitto, A., et al. (2014) · European Spine Journal · doi:10.1007/s00586-014-3540-3 · Cited by 86 · see citing works
Self-citation
Guideline Warfare Over Interventional Therapies for Low Back Pain: Can We Raise the Level of Discourse?
Chou, R., Atlas, S. J., Loeser, J. D., Rosenquist, R. W., & Stanos, S. P. (2011) · Journal of Pain · doi:10.1016/j.jpain.2011.04.012 · Cited by 83 · see citing works
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Reappraising entrapment neuropathies – Mechanisms, diagnosis and management
Schmid, A. B., Nee, R. J., & Coppieters, M. W. (2013) · Manual Therapy · doi:10.1016/j.math.2013.07.006 · Cited by 82 · see citing works
Patients’ perceived needs for medical services for non-specific low back pain: A systematic scoping review
Chou, L., Ranger, T. A., Peiris, W. L., Cicuttini, F., Urquhart, D. M., Sullivan, K., Seneviwickrama, M., Briggs, A. M., & Wluka, A. E. (2018) · PLoS ONE · doi:10.1371/journal.pone.0204885 · Cited by 80 · see citing works
Relieving Pain in America
Loeser, J. D. (2012) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e318230f6c1 · Cited by 78 · see citing works
Injection therapy and denervation procedures for chronic low-back pain: a systematic review
Henschke, N., Kuijpers, T., Rubinstein, S. M., van Middelkoop, M., Ostelo, R., Verhagen, A. P., Koes, B. W., & van Tulder, M. W. (2010) · European Spine Journal · doi:10.1007/s00586-010-1411-0 · Cited by 77 · see citing works
Peripheral Nerve Field Stimulation (PNFS) in Chronic Low Back Pain: A Prospective Multicenter Study
Kloimstein, H., Likar, R., Kern, M., Neuhold, J., Cada, M., Loinig, N., Ilias, W., Freundl, B., Binder, H., Wolf, A., et al. (2013) · Neuromodulation Technology at the Neural Interface · doi:10.1111/ner.12139 · Cited by 75 · see citing works
Answer to the Letter to the Editor of Koen Van Boxem et al. concerning manuscript “Injection therapy and denervation procedures for chronic low-back pain: a systematic review” by Henschke N, Kuijpers T, Rubinstein SM, van Middelkoop M, Ostelo R, Verhagen A, Koes BW, van Tulder MW, Eur Spine J, 2010
Henschke, N. (2010) · European Spine Journal · doi:10.1007/s00586-010-1581-9 · Cited by 71 · see citing works
Pain Management Injection Therapies for Low-back Pain
Chou, R. (2015) · Brown Digital Repository · doi:10.7301/z0ks6phj · Cited by 71 · see citing works
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Physical Therapy for Chronic Low Back Pain in North Carolina: Overuse, Underuse, or Misuse?
Freburger, J. K., Carey, T. S., & Holmes, M. (2011) · Physical Therapy · doi:10.2522/ptj.20100281 · Cited by 68 · see citing works
An Update of the Systematic Appraisal of the Accuracy and Utility of Lumbar Discography in Chronic Low Back Pain
Manchikanti, L. (2013) · Pain Physician · doi:10.36076/ppj.2013/16/se55 · Cited by 67 · see citing works
A Perfect Storm in Interventional Pain Management: Regulated, but Unbalanced
Benyamin, R. M. (2010) · Pain Physician · doi:10.36076/ppj.2010/13/109 · Cited by 66 · see citing works
Lumbosacral Radicular Pain
Boxem, K. V., Cheng, J., Patijn, J., van Kleef, M., Lataster, A., Mekhail, N. A., & Zundert, J. H. M. V. (2011) · doi:10.1002/9781119968375.ch11 · Cited by 66 · see citing works
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Nonsurgical Interventional Spine Pain Procedures
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Authors: Chou, R., Atlas, S. J., Stanos, S. P., & Rosenquist, R. W.
Affiliations: Oregon Health & Science University (US)
Harvard University (US)
Northwestern University (US)
University of Iowa (US)
Corresponding author: Chou, Roger
ORCID: Chou, Roger
Atlas, Steven J.
Rosenquist, Richard W.
Venue: Spine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2009-05
Volume: 34
Issue: 10
Pages: 1078-1093
ISSN: 0362-2436 (ISSN-L)
DOI: 10.1097/brs.0b013e3181a103b1
OpenAlex: W2057983082
Cited by: 392
References: 198
Citations by year: 2026: 7 · 2025: 3 · 2024: 2 · 2023: 9 · 2022: 10 · 2021: 22 · 2020: 22 · 2019: 17 · 2018: 13 · 2017: 20 · 2016: 19 · 2015: 33 · 2014: 36 · 2013: 38 · 2012: 41
FWCI: 5.53
Type: journal article
Language: en
Open access: closed
Locations: Spine (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5p60ar048094-05)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (P60-AR048094)
Topics: Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords: low back pain, radicular pain, sciatica, interventional pain management, epidural steroid injection, chemonucleolysis, spinal cord stimulation, failed back surgery syndrome, prolotherapy, facet joint injection, sacroiliac joint injection, medial branch block, radiofrequency denervation, radiofrequency thermocoagulation, botulinum toxin injection, local injection, lumbar disc herniation, radiculopathy
MeSH terms: Clinical Trials as Topic, Electric Stimulation Therapy, Humans, Injections, Epidural, Intervertebral Disc Chemolysis, Intervertebral Disc Displacement, Nerve Block, Radiculopathy, Treatment Outcome, Outcome Assessment, Health Care, Catheter Ablation, Low Back Pain, Practice Guidelines as Topic, Evidence-Based Medicine

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

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