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American Pain Society Offers Back Pain Treatment Guidance

Last Updated: May 18, 2009.

The American Pain Society has issued a new series of recommendations to guide clinicians deciding among the various surgical and nonsurgical options for treating low back pain. The guidelines are presented in separate studies in the May 1 issue of Spine.

MONDAY, May 18 (HealthDay News) -- The American Pain Society (APS) has issued a new series of recommendations to guide clinicians deciding among the various surgical and nonsurgical options for treating low back pain (LBP). The guidelines are presented in separate studies in the May 1 issue of Spine.

In one study, Roger Chou, M.D., of the Oregon Health and Science University in Portland, and colleagues on an APS panel reviewed 161 randomized trials to produce eight recommendations grouped by pain type (nonradicular or radicular). The guidelines cover types of diagnostic procedures and interdisciplinary rehabilitation, including cognitive/behavioral therapy, the use of corticosteroid injections, disk replacement, spinal cord stimulation, and surgery.

The journal also includes two other studies sponsored by the APS, separately reviewing the literature on surgical and nonsurgical LBP interventions. In the article focusing on nonsurgical interventions, Chou and colleagues reviewed 105 trials and 26 systematic reviews on a broad range of interventions, including botulinum toxin injection, prolotherapy, epidural steroid injection, chemonucleolysis, radiofrequency denervation, spinal cord stimulation and others. The researchers conclude that few nonsurgical treatments have been shown to be effective. In the article on surgical interventions, Chou and colleagues reviewed 84 trials and 22 systematic reviews and found surgery generally offered small or short-term benefits.

"Surgery for radiculopathy with herniated lumbar disc and symptomatic spinal stenosis is associated with short-term benefits compared to nonsurgical therapy, though benefits diminish with long-term follow-up in some trials. For nonradicular back pain with common degenerative changes, fusion is no more effective than intensive rehabilitation, but associated with small to moderate benefits compared to standard nonsurgical therapy," the authors conclude.

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