 |
|
American Pain Society's low back guideline expanded to cover interventional procedures
May 12, 2008For low-back pain patients and their doctors, the American Pain Society, www.ampainsoc.org, 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 panel's 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 Society's 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 doctor's 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.
American Pain Society
"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 doctor's 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.
American Pain Society
Low-back Pain Current Events and Low-back Pain News RSSAPS Issues New Guideline for Low-Back Pain Interventions, Surgery
The American Pain Society (APS) has issued a new clinical practice guideline for low back pain that emphasizes the use of noninvasive treatments over interventional procedures, as well as shared decision making between provider and patient.
New Treatment Guidelines For Low Back Pain
A summary of evidence on the diagnosis and treatment of low-back pain has prompted the American Pain Society (ASP) and the American College of Physicians (ACP) to issue a new treatment guideline.
Supplemental therapy can ease pain for people suffering from common jaw disorder
A new supplemental therapy that teaches pain coping and biofeedback skills can reduce pain, the potential for chronic pain and health-care costs for millions of Americans suffering from a common jaw disorder, UT Southwestern Medical Center researchers have found.
Stem cells can repair torn tendons or ligaments
Weekend athletes who overexert themselves running or playing basketball may one day reap the benefits of research at the Hebrew University of Jerusalem that shows that adult stem cells can be used to make new tendon or ligament tissue.
New study shows chiropractic is cost-effective in treating chronic back pain
A new study finds that chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes.
Medium-firm Mattresses Best For Low Back Pain (pp 1594, 1599)
The popular belief that firm mattresses are best for people with low back pain is challenged by the results of a randomised trial in this week's issue of THE LANCET. Mattresses of medium firmness were found to be more effective than firm mattresses in alleviating symptoms of back pain. Evidence surrounding the optimum firmness of bed mattresses is lacking; previous research has shown how three-quarters of orthopaedic physicians recommended firm bed mattresses to counter patients' low back pain. Francisco Kovacs from the Kovacs Foundation, Palma de Mallorca, Spain, and colleagues assessed the effect of different firmness of mattresses on the clinical course of patients with chronic non-specif
More Low-back Pain Current Events and Low-back Pain News Articles
 |
BV Medical Back Pain Relief System Tens Support Belt by BV Medical Back Pain Relief System Tens plus Support Belt. Electronic Massage System for Low Back Pain. Intended for the temporary relief of low back pain associated with sore and aching muscles due to strain from exercise or normal household work activities. Tens Technology - Transcutaneous Electrical Nerve Stimulation, Dual Channel Digital Stimulator with One Size Fits Most Support Belt. FDA Cleared for OTC sales, Now available without a prescription. Easy to use controls with 8 massage modes. Three timer modes. Clinically proven Rapid Relief for low back pain. |
 |
8 Steps to a Pain-Free Back: Natural Posture Solutions for Pain in the Back, Neck, Shoulder, Hip, Knee, and Foot (Remember When It Didn't Hurt) by Esther Gokhale (Author), Susan Adams (Editor) |
 |
SACRO WEDGY - The Back Aid Sacro Stabilizer - FEMALE VERSION - Helps Releive Back Pain by Sacro Wedgy In use almost 15 years, The Sacro Wedgy® has helped thousands get relief from a variety of symptoms such as sciatica, low back pain, hip pain, knee pain and more. Relaxing on a regular basis helps the muscles slowly rebalance using gravity to do most of the work. It is not a quick fix--nothing is; however, addressing and helping to correct bad posture and "out of balance" muscle structure helps treat the origin of the problem rather than treat the symptom. The Sacro Wedgy® is available in a male or female version. |
 |
Low Back Disorders, Second Edition by Stuart McGill (Author) Access the latest research and applications to build effective prevention and rehabilitation programs for your patients or clients with Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition. Internationally recognized low back specialist Stuart McGill presents original research to quantify the forces that specific movements and exercises impose on the low back, dispels myths regarding spine stabilization exercises, and suggests prevention approaches and strategies to offset injuries and restore function. Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition, presents a clear exposition of back anatomy and biomechanics and demonstrates how to interpret the latest research on low back involvement for clinical applications. The... |
 |
Dealing with Acute Low Back Pain Dealing With Acute Low Back Pain DVD was developed by Physical Therapist, Harry Benich, to enhance the progress and effectiveness of a physical therapy program for patients with Acute Low Back Injuries. Due to shrinking reimbursement by health insurances, physical therapists are very limited in the time they have with patients and often the treatment programs cannot be completed, restoring patients to full pre-injury status. Principles and basic skills are taught for most patients with spine or lumbo-pelvic injuries to prevent further injury and allow healing to occur as rapidly as possible. Included is a home-based circuit-style exercise program for restoring and building strength. This product is manufactured on demand using DVD-R recordable media. Amazon.com's standard return policy... |
 |
Low Back Pain (Medical Student Coach) by Medical Student Coach Low back pain is a common presentation of patients to the Internal Medicine clinic, Emergency Department, and other types of clinics. In preparation for the USMLE Step 1, USMLE Step 2 CK, USMLE Step 2 CS, and USMLE Step 3, medical students need to know the differential diagnosis, history and physical, assessment, and treatment for this common chief complaint. The Medical Student Coach series is here to help you tackle this. If you are a patient, this will give you great insight into what your doctors are thinking and the empowerment you need to ask questions. This book covers low back pain, lumbar pain, sacral pain, nerve root compression, nerve root disease, radiculopathy, cauda equina syndrome, spondylosis, disk herniation, spinal stenosis, spondylolisthesis , etc. |
![Low Back Pain Intermediate Exercises [VHS]](http://ecx.images-amazon.com/images/I/51KV71E2MCL._SL160_.jpg) |
Low Back Pain Intermediate Exercises [VHS] Directed By: John P. Lenhart D.C. M.D. Low Back Pain Intermediate Exercises - Part 2 of the "Video Comprehensive Rehabilitation Exercise Series" for Low Back Pain Rehabilitation. This series helps each person develop their own rehab/exercise routine at home. Depending upon your current level of activity, you will find a starting point that meets your individual performance level. The levels for each series are Gentle, Intermediate, Advanced and some have Strengthening. The Intermediate exercises have been found to be beneficial for those who have been decreased strength and limited mobility and moderate pain . "Get Moving To Get Better" is our motto on these tapes, and the sooner you start, the better chances you have to prevent adhesions, promote agility of joints, and decrease incompacitation. The intermediate exercises have... |
 |
Mueller Back Brace #4581 - Universal Sizing by Mueller Back Brace One Size Fits Most This adjustable back brace provides firm, comfortable support to help relieve back pain. Ideal for back strains and sprains, moderate disc and arthritic conditions, sciatica, muscle spasms, chronic unstable lumbar spine, and strains of sacroiliac area. Lightweight, breathable fabric for all-day wear. |
 |
The Original McKenzie Airback TM Inflatable Roll #706 by McKenzie The Original McKenzie® AirBackTM Inflatable Lumbar Roll is at the request of patients who wanted a portable and discreet means of short-term low back support. This roll folds to about the size a wallet when not in use. It easily inflates in seconds. Vary the air pressure to get the desired degree of firmness. Latex free constuction. |
 |
Portable Ultrasound with multiple settings + 8 oz Bottle of Naturally Medicated Lavender Infusion Ultrasound Gel by MendMeShop Over 14,600 people have purchased the MendMeShop Portable Ultrasound to treat muscle injuries, tendonitis, ligament problems, bursitis, and more. Our Amazon feedback is proof it works. Need more assurance? All of our products are backed by a 60 day money back guarantee and 5 year warranty. Many doctors and physical therapists recommend ultrasound to treat muscle and soft tissue injuries. Medical studies from leading institutions such as Oxford, Mayo Clinic, and more attest to the effectiveness of this therapy. Our ultrasound is similar in many regards to the devices used during these studies.... |
| © 2009 BrightSurf.com |