Cargando…
Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group
BACKGROUND: The past two decades have witnessed a surge in the use of lumbar facet blocks and radiofrequency ablation (RFA) to treat low back pain (LBP), yet nearly all aspects of the procedures remain controversial. METHODS: After approval by the Board of Directors of the American Society of Region...
Autores principales: | , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362874/ https://www.ncbi.nlm.nih.gov/pubmed/32245841 http://dx.doi.org/10.1136/rapm-2019-101243 |
_version_ | 1783559577199968256 |
---|---|
author | Cohen, Steven P Bhaskar, Arun Bhatia, Anuj Buvanendran, Asokumar Deer, Tim Garg, Shuchita Hooten, W Michael Hurley, Robert W Kennedy, David J McLean, Brian C Moon, Jee Youn Narouze, Samer Pangarkar, Sanjog Provenzano, David Anthony Rauck, Richard Sitzman, B Todd Smuck, Matthew van Zundert, Jan Vorenkamp, Kevin Wallace, Mark S Zhao, Zirong |
author_facet | Cohen, Steven P Bhaskar, Arun Bhatia, Anuj Buvanendran, Asokumar Deer, Tim Garg, Shuchita Hooten, W Michael Hurley, Robert W Kennedy, David J McLean, Brian C Moon, Jee Youn Narouze, Samer Pangarkar, Sanjog Provenzano, David Anthony Rauck, Richard Sitzman, B Todd Smuck, Matthew van Zundert, Jan Vorenkamp, Kevin Wallace, Mark S Zhao, Zirong |
author_sort | Cohen, Steven P |
collection | PubMed |
description | BACKGROUND: The past two decades have witnessed a surge in the use of lumbar facet blocks and radiofrequency ablation (RFA) to treat low back pain (LBP), yet nearly all aspects of the procedures remain controversial. METHODS: After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, letters were sent to a dozen pain societies, as well as representatives from the US Departments of Veterans Affairs and Defense. A steering committee was convened to select preliminary questions, which were revised by the full committee. Questions were assigned to 4–5 person modules, who worked with the Subcommittee Lead and Committee Chair on preliminary versions, which were sent to the full committee. We used a modified Delphi method, whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chair, who incorporated the comments and sent out revised versions until consensus was reached. RESULTS: 17 questions were selected for guideline development, with 100% consensus achieved by committee members on all topics. All societies except for one approved every recommendation, with one society dissenting on two questions (number of blocks and cut-off for a positive block before RFA), but approving the document. Specific questions that were addressed included the value of history and physical examination in selecting patients for blocks, the value of imaging in patient selection, whether conservative treatment should be used before injections, whether imaging is necessary for block performance, the diagnostic and prognostic value of medial branch blocks (MBB) and intra-articular (IA) injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for a prognostic block, how many blocks should be performed before RFA, how electrodes should be oriented, the evidence for larger lesions, whether stimulation should be used before RFA, ways to mitigate complications, if different standards should be applied to clinical practice and clinical trials and the evidence for repeating RFA (see table 12 for summary). CONCLUSIONS: Lumbar medial branch RFA may provide benefit to well-selected individuals, with MBB being more predictive than IA injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of more false-negatives. Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice. |
format | Online Article Text |
id | pubmed-7362874 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-73628742020-07-16 Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group Cohen, Steven P Bhaskar, Arun Bhatia, Anuj Buvanendran, Asokumar Deer, Tim Garg, Shuchita Hooten, W Michael Hurley, Robert W Kennedy, David J McLean, Brian C Moon, Jee Youn Narouze, Samer Pangarkar, Sanjog Provenzano, David Anthony Rauck, Richard Sitzman, B Todd Smuck, Matthew van Zundert, Jan Vorenkamp, Kevin Wallace, Mark S Zhao, Zirong Reg Anesth Pain Med Special Article BACKGROUND: The past two decades have witnessed a surge in the use of lumbar facet blocks and radiofrequency ablation (RFA) to treat low back pain (LBP), yet nearly all aspects of the procedures remain controversial. METHODS: After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, letters were sent to a dozen pain societies, as well as representatives from the US Departments of Veterans Affairs and Defense. A steering committee was convened to select preliminary questions, which were revised by the full committee. Questions were assigned to 4–5 person modules, who worked with the Subcommittee Lead and Committee Chair on preliminary versions, which were sent to the full committee. We used a modified Delphi method, whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chair, who incorporated the comments and sent out revised versions until consensus was reached. RESULTS: 17 questions were selected for guideline development, with 100% consensus achieved by committee members on all topics. All societies except for one approved every recommendation, with one society dissenting on two questions (number of blocks and cut-off for a positive block before RFA), but approving the document. Specific questions that were addressed included the value of history and physical examination in selecting patients for blocks, the value of imaging in patient selection, whether conservative treatment should be used before injections, whether imaging is necessary for block performance, the diagnostic and prognostic value of medial branch blocks (MBB) and intra-articular (IA) injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for a prognostic block, how many blocks should be performed before RFA, how electrodes should be oriented, the evidence for larger lesions, whether stimulation should be used before RFA, ways to mitigate complications, if different standards should be applied to clinical practice and clinical trials and the evidence for repeating RFA (see table 12 for summary). CONCLUSIONS: Lumbar medial branch RFA may provide benefit to well-selected individuals, with MBB being more predictive than IA injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of more false-negatives. Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice. BMJ Publishing Group 2020-06 2020-04-03 /pmc/articles/PMC7362874/ /pubmed/32245841 http://dx.doi.org/10.1136/rapm-2019-101243 Text en © American Society of Regional Anesthesia & Pain Medicine 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, an indication of whether changes were made, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Special Article Cohen, Steven P Bhaskar, Arun Bhatia, Anuj Buvanendran, Asokumar Deer, Tim Garg, Shuchita Hooten, W Michael Hurley, Robert W Kennedy, David J McLean, Brian C Moon, Jee Youn Narouze, Samer Pangarkar, Sanjog Provenzano, David Anthony Rauck, Richard Sitzman, B Todd Smuck, Matthew van Zundert, Jan Vorenkamp, Kevin Wallace, Mark S Zhao, Zirong Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group |
title | Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group |
title_full | Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group |
title_fullStr | Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group |
title_full_unstemmed | Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group |
title_short | Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group |
title_sort | consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group |
topic | Special Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362874/ https://www.ncbi.nlm.nih.gov/pubmed/32245841 http://dx.doi.org/10.1136/rapm-2019-101243 |
work_keys_str_mv | AT cohenstevenp consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT bhaskararun consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT bhatiaanuj consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT buvanendranasokumar consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT deertim consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT gargshuchita consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT hootenwmichael consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT hurleyrobertw consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT kennedydavidj consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT mcleanbrianc consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT moonjeeyoun consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT narouzesamer consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT pangarkarsanjog consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT provenzanodavidanthony consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT rauckrichard consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT sitzmanbtodd consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT smuckmatthew consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT vanzundertjan consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT vorenkampkevin consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT wallacemarks consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup AT zhaozirong consensuspracticeguidelinesoninterventionsforlumbarfacetjointpainfromamultispecialtyinternationalworkinggroup |