Low–Back-Pain Interventional Guidelines Issued by American Pain Society

Low–Back-Pain Interventional Guidelines Issued by American Pain
Society

Evidence-based guidance for intervention
in patients with chronic low back pain has been issued by the American Pain
Society and appears in Spine.

Here are the principal recommendations.

In patients with nonradicular pain:

Interdisciplinary
rehabilitation emphasizing cognitive-behavioral approaches should be
considered for those who don't respond to usual interventions.
Provocative
discography (injecting material into a disc nucleus in an attempt to
reproduce the patient's typical pain) is not recommended.
Facet joint
corticosteroid injection, prolotherapy (repeated injections of irritant
material to stimulate an inflammatory response), and intradiscal
corticosteroid injection are not recommended.
Persistent
disabling symptoms and degenerative spinal changes should prompt
discussion and shared decision-making regarding surgery or
interdisciplinary rehabilitation (there is insufficient evidence to weigh
the use of vertebral disc replacement in these patients).

In patients with persistent
radiculopathy:

Those with
herniated discs should be offered discussion about the use of epidural
steroid injection.
Those with
herniated discs and disabling leg pain from spinal stenosis should be
offered discussion about surgery.
Those with
persistent pain after surgery should be offered discussion on the risks
and benefits of spinal cord stimulation.

Physician's
First Watch for May 15, 2009

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Low–Back-Pain Interventional Guidelines Issued by American Pain Society Dralatwani2gif

Thanks Dr.Salim Alatwani for these useful recommendation .

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خالص شكري وتقديري د-عبد الهادي الجريصي </p>
<p> Low–Back-Pain Interventional Guidelines Issued by American Pain Society HaveANicedayRose

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