The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain

Dawood Sayed; Jay Grider; Natalie Strand; Jonathan M Hagedorn; Steven Falowski; Christopher M Lam; Vinicius Tieppo Francio; Douglas P Beall; Nestor D Tomycz; Justin R Davanzo; Rohit Aiyer; David W Lee; Hemant Kalia; Soun Sheen; Mark N Malinowski; Michael Verdolin; Shashank Vodapally; Alexios Carayannopoulos; Sameer Jain; Nomen Azeem; Reda Tolba; George C Chang Chien; Priyanka Ghosh; Anthony J Mazzola; Kasra Amirdelfan; Krishnan Chakravarthy; Erika Petersen; Michael E Schatman; Timothy Deer

doi:10.2147/JPR.S386879

The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain

J Pain Res. 2022 Dec 6:15:3729-3832. doi: 10.2147/JPR.S386879. eCollection 2022.

Authors

Dawood Sayed¹, Jay Grider², Natalie Strand³, Jonathan M Hagedorn⁴, Steven Falowski⁵, Christopher M Lam¹, Vinicius Tieppo Francio⁶, Douglas P Beall⁷, Nestor D Tomycz⁸, Justin R Davanzo⁹, Rohit Aiyer¹⁰, David W Lee¹¹, Hemant Kalia^{12

13}, Soun Sheen¹³, Mark N Malinowski^{14

15}, Michael Verdolin¹⁶, Shashank Vodapally¹⁷, Alexios Carayannopoulos^{18

19

20}, Sameer Jain²¹, Nomen Azeem^{22

23}, Reda Tolba^{24

25}, George C Chang Chien^{26

27}, Priyanka Ghosh²⁸, Anthony J Mazzola²⁹, Kasra Amirdelfan³⁰, Krishnan Chakravarthy^{31

32}, Erika Petersen³³, Michael E Schatman^{34

35}, Timothy Deer³⁶

Affiliations

¹ Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA.
² University of Kentucky, Lexington, KY, USA.
³ Interventional Pain Management, Mayo Clinic, Scottsdale, AZ, USA.
⁴ iSpine Pain Physicians, Maple Grove, MN, USA.
⁵ Functional Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA.
⁶ Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
⁷ Comprehensive Specialty Care, Edmond, OK, USA.
⁸ AHN Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA.
⁹ AHN Neurosurgery, Forbes Hospital, Monroeville, PA, USA.
¹⁰ Interventional Pain Management and Pain Psychiatry, Henry Ford Health System, Detroit, MI, USA.
¹¹ Physical Medicine & Rehabilitation and Pain Medicine, Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA.
¹² Rochester Regional Health System, Rochester, NY, USA.
¹³ Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA.
¹⁴ Adena Spine Center, Adena Health System, Chillicothe, OH, USA.
¹⁵ Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA.
¹⁶ Anesthesiology and Pain Medicine, Pain Consultants of San Diego, San Diego, CA, USA.
¹⁷ Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA.
¹⁸ Department of Physical Medicine and Rehabilitation, Rhode Island Hospital, Newport Hospital, Lifespan Physician Group, Providence, RI, USA.
¹⁹ Comprehensive Spine Center at Rhode Island Hospital, Newport Hospital, Providence, RI, USA.
²⁰ Neurosurgery, Brown University, Providence, RI, USA.
²¹ Interventional Pain Management, Pain Treatment Centers of America, Little Rock, AR, USA.
²² Department of Neurology, University of South Florida, Tampa, FL, USA.
²³ Florida Spine & Pain Specialists, Riverview, FL, USA.
²⁴ Pain Management, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
²⁵ Anesthesiology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
²⁶ Pain Management, Ventura County Medical Center, Ventura, CA, USA.
²⁷ Center for Regenerative Medicine, University Southern California, Los Angeles, CA, USA.
²⁸ Remedy Medical Group, San Francisco, CA, USA.
²⁹ Mount Sinai Health System, New York City, NY, USA.
³⁰ IPM Medical Group, Inc., Walnut Creek, CA, USA.
³¹ Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA, USA.
³² Va San Diego Healthcare, San Diego, CA, USA.
³³ Department of Neurosurgery, University of Arkansas for Medical Science, Little Rock, AR, USA.
³⁴ Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA.
³⁵ Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA.
³⁶ The Spine and Nerve Center of the Virginias, Charleston, WV, USA.

Abstract

Introduction: Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety.

Objective: The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders.

Methods: The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented.

Results: After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain.

Conclusion: The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.

Keywords: back pain; clinical guideline; epidural steroid injection; intervention; lumbar disorder; minimally invasive spine procedure; radiofrequency ablation; spinal cord stimulation.

Publication types

Review