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

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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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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 › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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