ACTIPATCH/RECOVERYRX IS THE SOLUTION - JUST NEED TO FIGURE OUT HOW TO LET THE WORLD KNOW!!!
Actipatch/RecoveryRX can change the "entrenched culture" that Dr. Ballantyne refers to below!
Healio - February 20, 2025 - 2 min read
New recommendations urge against spine injections for chronic back pain
ByAndrew (Drew) Rhoades
Fact checked byCarol L. DiBerardino, MLA, ELS
Key takeaways:
An international panel found no high certainty evidence on conventional procedures for spine pain.
The panel concluded that such procedures are costly, burdensome and do not provide meaningful relief.
Spine injections should not be given to adults with chronic back pain because they provide little or no pain relief vs. sham injections, according to new clinical practice guidelines.
The recommendations, published in BMJ and developed in partnership with the nonprofit MAGIC group, apply to adults with moderate to severe chronic axial or radicular spine pain that is not related to cancer and has lasted for at least 3 months.
An international panel found no high certainty evidence on conventional procedures like epidural injections for spine pain.
Low back pain remains the leading worldwide cause of years lived with disability, while such pain could impact more than 800 million people by 2050.
According to Jason W. Busse, DC, PhD, a professor at McMaster University in Canada, and colleagues, current procedures for low back pain like nerve blocks, nerve ablation and epidural injections are being increasingly used, but evidence is lacking to support the efficacy of these treatments.
An international panel made up of 10 clinicians, eight methodologists and four people living with chronic back pain conducted an analysis of evidence on procedures using the Grading of Recommendations Assessment, Development and Evaluation approach.
The panel compared the benefits and harms of 13 interventional procedures or combinations of procedures for chronic, noncancer back pain against sham treatments using the data of a systematic review and meta-analysis on randomized trials and observational studies.
Procedures that were assessed included:
epidural injections of local anesthetic, steroids or a combination;
injections of local anesthetic, steroids or a combination; and
radiofrequency ablation with or without local anesthetic plus steroid injections.
No high certainty evidence found
The panel concluded that there was no high certainty evidence for any of the procedures or combinations of procedures, while low and moderate certainty evidence indicate that spine injections would provide no meaningful relief for pain in a specific area of the spine or pain radiating from the spine to the arms or legs compared with sham injections.
The procedures are costly, “burdensome and may result in adverse events,” the experts wrote, adding that almost all informed patients would choose to forgo them due to the little or no benefit received.
The panel noted that there are several remaining questions that future research could attempt to answer, such as if there are systematic differences in treatment effects of interventional procedures based on subtypes of chronic spine pain and what the effects treatments may have on patient outcomes — which were poorly reported in trials — like returning to work, sleep quality, mental functioning and opioid use.
Independent analysis
In an accompanying editorial, Jane C. Ballantyne, MD, FRCA, an anesthesiologist at the University of Washington Medical Center, explained that the guidance raises the question of whether such treatments should still be offered to those with chronic back pain.
“It is never easy to change entrenched culture, and injections have undoubtedly become entrenched as a key component of pain clinic treatments,” she wrote.
One way to change the behavior of patients and physicians when it comes to these treatments “is through financial incentive,” Ballantyne added.
“Yes, there are many pressures on providers to keep doing spine injections, and on payers to keep paying for them, but the more the evidence fails to support the widespread use of these injections, the less inclined health care systems will be to fund them.”
From another publication (BMJ):
Experts strongly recommend against spine injections for chronic back pain
Commonly used injections offer little or no pain relief, says expert panel
Findings question whether it’s reasonable to continue to offer these procedures outside of clinical trials
Spine injections should not be given to adults with chronic back pain because they provide little or no pain relief compared with sham injections, say a panel of international experts in The BMJ today.
Their strong recommendations apply to procedures such as epidural steroid injections and nerve blocks for people living with chronic back pain (lasting at least 3 months) that is not associated with cancer, infection or inflammatory arthritis.
Their advice is based on the latest evidence and is part of The BMJ’s ‘Rapid Recommendations’ initiative – to produce rapid and trustworthy guidance based on new evidence to help doctors make better decisions with their patients.
Chronic back pain is the leading cause of disability worldwide. It is estimated to affect 1 in 5 adults aged 20-59, with higher rates likely among older adults. In 2016, low back and neck pain accounted for the highest healthcare spending in the US at $134.5 billion.
Procedures such as epidural steroid injections, nerve blocks and radiofrequency ablation (using radio waves to destroy nerves) are widely used to stop pain signals reaching the brain, but current guidelines provide conflicting recommendations for their use.
So an international panel, made up of clinicians, people living with chronic spine pain, and research methodologists, carried out a detailed analysis of the latest evidence using the GRADE approach (a system used to assess the quality of evidence).
This evidence, based on reviews of randomised trials and observational studies, compared the benefits and harms of 13 common interventional procedures, or combinations of procedures, for chronic, non-cancer spine pain against sham procedures.
After careful consideration, the panel concluded that there was no high certainty evidence for any procedure or combination of procedures, and all low and moderate certainty evidence suggests no meaningful relief for either axial pain (in a specific area of the spine) or radicular pain (radiating from the spine to the arms or legs) for spine injections compared with sham procedures. As such, they strongly recommend against their use.
This includes injections of local anaesthetic, steroids, or their combination; epidural injections of local anaesthetic, steroids, or their combination; and radiofrequency ablation with or without local anaesthetic plus steroid injections.
The panel added that these procedures are costly, a burden on patients, and carry a small risk of harm. As such, they say almost all informed patients would choose to avoid them.
Finally, they acknowledge that further research is warranted and may alter future recommendations, in particular for procedures currently supported by only low or very low certainty evidence of effectiveness. Further research is also needed to establish the effects of interventional procedures on important outcomes for patients such as opioid use, return to work, and sleep quality.
In a linked editorial, Jane Ballantyne at the University of Washington says the question this recommendation raises is whether it is reasonable to continue to offer these procedures to people with chronic back pain.
It is never easy to change entrenched culture, she writes, “but the more the evidence fails to support the widespread use of these injections, the less inclined healthcare systems will be to fund them.”
“This will not be the last word on spine injections for chronic back pain, but it adds to a growing sense that chronic pain management needs a major rethink that is perhaps best achieved by a better balance of reimbursements between procedural and non-procedural chronic pain treatments,” she concludes.
20/02/2025
Actipatch/RecoveryRX can change the "entrenched culture" that Dr. Ballantyne refers to below!
Healio - February 20, 2025 - 2 min read
New recommendations urge against spine injections for chronic back pain
ByAndrew (Drew) Rhoades
Fact checked byCarol L. DiBerardino, MLA, ELS
Key takeaways:
An international panel found no high certainty evidence on conventional procedures for spine pain.
The panel concluded that such procedures are costly, burdensome and do not provide meaningful relief.
Spine injections should not be given to adults with chronic back pain because they provide little or no pain relief vs. sham injections, according to new clinical practice guidelines.
The recommendations, published in BMJ and developed in partnership with the nonprofit MAGIC group, apply to adults with moderate to severe chronic axial or radicular spine pain that is not related to cancer and has lasted for at least 3 months.
An international panel found no high certainty evidence on conventional procedures like epidural injections for spine pain.
Low back pain remains the leading worldwide cause of years lived with disability, while such pain could impact more than 800 million people by 2050.
According to Jason W. Busse, DC, PhD, a professor at McMaster University in Canada, and colleagues, current procedures for low back pain like nerve blocks, nerve ablation and epidural injections are being increasingly used, but evidence is lacking to support the efficacy of these treatments.
An international panel made up of 10 clinicians, eight methodologists and four people living with chronic back pain conducted an analysis of evidence on procedures using the Grading of Recommendations Assessment, Development and Evaluation approach.
The panel compared the benefits and harms of 13 interventional procedures or combinations of procedures for chronic, noncancer back pain against sham treatments using the data of a systematic review and meta-analysis on randomized trials and observational studies.
Procedures that were assessed included:
epidural injections of local anesthetic, steroids or a combination;
injections of local anesthetic, steroids or a combination; and
radiofrequency ablation with or without local anesthetic plus steroid injections.
No high certainty evidence found
The panel concluded that there was no high certainty evidence for any of the procedures or combinations of procedures, while low and moderate certainty evidence indicate that spine injections would provide no meaningful relief for pain in a specific area of the spine or pain radiating from the spine to the arms or legs compared with sham injections.
The procedures are costly, “burdensome and may result in adverse events,” the experts wrote, adding that almost all informed patients would choose to forgo them due to the little or no benefit received.
The panel noted that there are several remaining questions that future research could attempt to answer, such as if there are systematic differences in treatment effects of interventional procedures based on subtypes of chronic spine pain and what the effects treatments may have on patient outcomes — which were poorly reported in trials — like returning to work, sleep quality, mental functioning and opioid use.
Independent analysis
In an accompanying editorial, Jane C. Ballantyne, MD, FRCA, an anesthesiologist at the University of Washington Medical Center, explained that the guidance raises the question of whether such treatments should still be offered to those with chronic back pain.
“It is never easy to change entrenched culture, and injections have undoubtedly become entrenched as a key component of pain clinic treatments,” she wrote.
One way to change the behavior of patients and physicians when it comes to these treatments “is through financial incentive,” Ballantyne added.
“Yes, there are many pressures on providers to keep doing spine injections, and on payers to keep paying for them, but the more the evidence fails to support the widespread use of these injections, the less inclined health care systems will be to fund them.”
From another publication (BMJ):
Experts strongly recommend against spine injections for chronic back pain
Commonly used injections offer little or no pain relief, says expert panel
Findings question whether it’s reasonable to continue to offer these procedures outside of clinical trials
Spine injections should not be given to adults with chronic back pain because they provide little or no pain relief compared with sham injections, say a panel of international experts in The BMJ today.
Their strong recommendations apply to procedures such as epidural steroid injections and nerve blocks for people living with chronic back pain (lasting at least 3 months) that is not associated with cancer, infection or inflammatory arthritis.
Their advice is based on the latest evidence and is part of The BMJ’s ‘Rapid Recommendations’ initiative – to produce rapid and trustworthy guidance based on new evidence to help doctors make better decisions with their patients.
Chronic back pain is the leading cause of disability worldwide. It is estimated to affect 1 in 5 adults aged 20-59, with higher rates likely among older adults. In 2016, low back and neck pain accounted for the highest healthcare spending in the US at $134.5 billion.
Procedures such as epidural steroid injections, nerve blocks and radiofrequency ablation (using radio waves to destroy nerves) are widely used to stop pain signals reaching the brain, but current guidelines provide conflicting recommendations for their use.
So an international panel, made up of clinicians, people living with chronic spine pain, and research methodologists, carried out a detailed analysis of the latest evidence using the GRADE approach (a system used to assess the quality of evidence).
This evidence, based on reviews of randomised trials and observational studies, compared the benefits and harms of 13 common interventional procedures, or combinations of procedures, for chronic, non-cancer spine pain against sham procedures.
After careful consideration, the panel concluded that there was no high certainty evidence for any procedure or combination of procedures, and all low and moderate certainty evidence suggests no meaningful relief for either axial pain (in a specific area of the spine) or radicular pain (radiating from the spine to the arms or legs) for spine injections compared with sham procedures. As such, they strongly recommend against their use.
This includes injections of local anaesthetic, steroids, or their combination; epidural injections of local anaesthetic, steroids, or their combination; and radiofrequency ablation with or without local anaesthetic plus steroid injections.
The panel added that these procedures are costly, a burden on patients, and carry a small risk of harm. As such, they say almost all informed patients would choose to avoid them.
Finally, they acknowledge that further research is warranted and may alter future recommendations, in particular for procedures currently supported by only low or very low certainty evidence of effectiveness. Further research is also needed to establish the effects of interventional procedures on important outcomes for patients such as opioid use, return to work, and sleep quality.
In a linked editorial, Jane Ballantyne at the University of Washington says the question this recommendation raises is whether it is reasonable to continue to offer these procedures to people with chronic back pain.
It is never easy to change entrenched culture, she writes, “but the more the evidence fails to support the widespread use of these injections, the less inclined healthcare systems will be to fund them.”
“This will not be the last word on spine injections for chronic back pain, but it adds to a growing sense that chronic pain management needs a major rethink that is perhaps best achieved by a better balance of reimbursements between procedural and non-procedural chronic pain treatments,” she concludes.
20/02/2025
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