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Pain Management Injection Therapies for Low Back Pain Appendixes Pain Management Injection Therapies for Low Back Pain Appendixes Project ID: ESIB0813 Original Publication: March 20, 2015 Revised Publication: July 10, 2015 Pacific Northwest Evidence-based Practice Center Roger Chou, MD, FACP Robin Hashimoto, PhD Janna Friedly, MD Rochelle Fu, PhD Tracy Dana, MLS Sean Sullivan, PhD Christina Bougatsos, MPH Jeffrey Jarvik, MD, MPH Appendix A. Search Strategies Database: Ovid MEDLINE(R) without Revisions 1 Low Back Pain/ or Spinal Stenosis/ or Radiculopathy/ or ("low back pain" or "spinal adj3 stenosis" or "radiculopathy").mp. 2 spine/ or coccyx/ or intervertebral disk/ or lumbar vertebrae/ or sacrum/ or spinal canal/ or exp back/ or facet joint/ or zygapophysial joint/ or sacroiliac.mp. 3 Chronic Pain/ or (chronic adj3 pain).mp. 4 2 and 3 5 1 or 4 6 Patient Selection/ 7 exp Treatment Outcome/ 8 Prognosis/ or (prognosis or prognostic).mp. 9 (patient$ adj5 select$).mp. 10 (select$ adj5 method$).mp. 11 or/6-10 12 exp Injections, Spinal/ or exp Injections, Intra-Articular/ 13 ((spine$ or spinal$ or epidural or facet or sacroiliac or "medial branch") adj5 (block or injection$)).mp. 14 12 or 13 15 5 and 14 16 5 and 11 17 16 and inject*.mp. 18 11 and 14 19 18 and "low back pain".mp. 20 15 or 17 or 19 21 20 and (random* or control* or cohort).mp. 22 limit 21 to yr="2008 - 2014" Database: EBM Reviews - Cochrane Central Register of Controlled Trials 1 Low Back Pain/ or Spinal Stenosis/ or Radiculopathy/ or ("low back pain" or "spinal adj3 stenosis" or "radiculopathy").mp. 2 spine/ or coccyx/ or intervertebral disk/ or lumbar vertebrae/ or sacrum/ or spinal canal/ or exp back/ or facet joint/ or zygapophysial joint/ or sacroiliac.mp. 3 Chronic Pain/ or (chronic adj3 pain).mp. 4 2 and 3 5 1 or 4 6 Patient Selection/ 7 exp Treatment Outcome/ 8 Prognosis/ or (prognosis or prognostic).mp. 9 (patient$ adj5 select$).mp. 10 (select$ adj5 method$).mp. 11 or/6-10 12 exp Injections, Spinal/ or exp Injections, Intra-Articular/ 13 ((spine$ or spinal$ or epidural or facet or sacroiliac or "medial branch") adj5 (block or injection$)).mp. A-1 Appendix A. Search Strategies 14 12 or 13 15 5 and 14 16 5 and 11 17 16 and inject*.mp. 18 11 and 14 19 18 and "low back pain".mp. 20 15 or 17 or 19 (1306) 21 limit 20 to yr="2008 - 2014" Database: EBM Reviews - Cochrane Database of Systematic Reviews 1 low back pain.ti. 2 1 and (epidural or facet or sacroiliac or "medial branch" or injection).mp. A-2 Appendix B. PICOTS PICOT Include Exclude Population • For all KQs: Adults with subacute (4 to 12 weeks) or chronic • Persons younger than 18 and (>12 weeks) symptoms of the following: years of age Conditions of o For epidural corticosteroid injections-Nonradicular low Interest back pain, low back pain with radiculopathy, or spinal stenosis o For facet joint corticosteroid injection and medial branch block- Nonradicular low back pain o For sacroiliac joint corticosteroid injection-Nonradicular back pain in the sacroiliac region Interventions • All KQs: Epidural corticosteroid injection, facet joint • Intraspinal injections corticosteroid injection, medial branch block, sacroiliac joint involving anti-tumor corticosteroid joint injection necrosis factor agents, radiofrequency denervation, intradiscal electrothermal therapy, chemonucleolysis, and intradiscal methylene blue or ozone Comparators • For KQ 2: Studies that evaluate the effects of patient • Uncontrolled or pre-post characteristics (e.g., age, sex, duration of pain, pain level, studies expectations of treatment benefits, confidence in clinician, worker’s compensation status, ongoing litigation, smoking status, or other treatment received) or findings with interventional diagnostic techniques (e.g., discography, selective nerve root block, facet joint block, medial branch block, sacroiliac joint block), imaging studies, and/or other clinical criteria. • For KQs 1, 3, and 4: Saline epidural, epidural with local anesthetic, nonepidural injection, no injection, surgery, or nonsurgical therapies. Outcomes • For KQs 1 2, 3: Pain, function, quality of life, opioid use, subsequent surgery, health care utilization • For KQ 4: Harms, including bleeding, infection, neurological events, and systemic complications, such as weight gain, diabetes, osteoporosis, and other endocrinological effects Timing • For all KQs: Outcomes measured 1 week or later after the injection; durability of treatment response will be assessed Setting • For all KQs: No restrictions Study • For KQs 1-3: randomized trials Design • For KQ 4: randomized trials or controlled cohort studies KQ=key question; PICOT=populations; interventions, comparators, outcomes, timing, setting. B-1 Appendix C. Included Studies Please refer to this section as a reference list for Appendixes E and F. Ackerman WE, 3rd, Ahmad M. The efficacy of Burgher AH, Hoelzer BC, Schroeder DR, et al. lumbar epidural steroid injections in patients with Transforaminal epidural clonidine versus lumbar disc herniations. Anesth Analg. 2007 corticosteroid for acute lumbosacral radiculopathy due May;104(5):1217-22, tables of contents. PMID: to intervertebral disc herniation. Spine. 2011 Mar 17456677. 1;36(5):E293-300. PMID: 21192304. Ackerman WE, 3rd, Ahmad M. Pain relief with Bush K, Hillier S. A controlled study of caudal intraarticular or medial branch nerve blocks in patients epidural injections of triamcinolone plus procaine for with positive lumbar facet joint SPECT imaging: a 12- the management of intractable sciatica. Spine (Phila week outcome study. South Med J. 2008;101(9):931- Pa 1976). 1991 May;16(5):572-5. PMID: 2053000. 4. PMID: 18708988. Buttermann GR. Treatment of lumbar disc herniation: Ahadian FM, McGreevy K, Schulteis G. Lumbar epidural steroid injection compared with discectomy. transforaminal epidural dexamethasone: a prospective, A prospective, randomized study. J Bone Joint Surg randomized, double-blind, dose-response trial. Reg Am. 2004 Apr;86-A(4):670-9. PMID: 15069129. Anesth Pain Med. 2011 Nov-Dec;36(6):572-8. PMID: 22005659. Candido KD, Raghavendra MS, Chinthagada M, et al. A prospective evaluation of iodinated contrast flow Arden NK, Price C, Reading I, et al. A multicentre patterns with fluoroscopically guided lumbar epidural randomized controlled trial of epidural corticosteroid steroid injections: the lateral parasagittal interlaminar injections for sciatica: the WEST study. epidural approach versus the transforaminal epidural Rheumatology (Oxford). 2005 Nov;44(11):1399-406. approach. Anesth Analg. 2008 of contents, 2008 PMID: 16030082. Feb;106(2):638-44. PMID: 18227326. Aronsohn J, Chapman K, Soliman M, et al. Candido KD, Rana MV, Sauer R, et al. Concordant Percutaneous microdiscectomy versus epidural pressure paresthesia during interlaminar lumbar injection for management of chronic spinal pain. Proc epidural steroid injections correlates with pain relief in West Pharmacol Soc. 2010;53:16-9. PMID: 22128444. patients with unilateral radicular pain. Pain Physician. 2013;16(5):497-511. PMID: 24077196. Becker C, Heidersdorf S, Drewlo S, et al. Efficacy of epidural perineural injections with autologous Carette S, Leclaire R, Marcoux S, et al. Epidural conditioned serum for lumbar radicular compression: corticosteroid injections for sciatica due to herniated an investigator-initiated, prospective, double-blind, nucleus pulposus. N Engl J Med. 1997 Jun reference-controlled study. Spine (Phila Pa 1976). 5;336(23):1634-40. PMID: 9171065. 2007 Aug 1;32(17):1803-8. PMID: 17762286. Carette S, Marcoux S, Truchon R, et al. A controlled Beliveau P. A comparison between epidural trial of corticosteroid injections into facet joints for anaesthesia with and without corticosteroid in the chronic low back pain. N Engl J Med. 1991 Oct treatment of sciatica. Rheumatol Phys Med. 1971 3;325(14):1002-7. PMID: 1832209. Feb;11(1):40-3. PMID: 5551095. Civelek E, Cansever T, Kabatas S, et al. Comparison Breivik H, Hesla P, Molnar I, et al. Treatment of of effectiveness of facet joint injection and chronic low back pain and sciatica. Comparison of radiofrequency denervation in chronic low back pain. caudal epidural injections of bupivacaine and Turk Neurosurg. 2012;22(2):200-6. PMID: 22437295. methylprednisolone with bupivacaine followed by saline. Adv Pain Res Ther. 1976;1:927-32. PMID: No Cocelli LP, Karakurum G, Cebesoy O, et al. Clinical PMID. comparison of effectiveness of epidural triamcinolone and betamethasone in discal radiculalgia: a Brown LL. A double-blind, randomized, prospective prospective, randomized study. Journal of study of epidural steroid injection vs. the mild Musculoskeletal Pain. 2009;17(3):281-6. procedure in patients with symptomatic lumbar spinal stenosis. Pain pract. 2012 Jun;12(5):333-41. PMID: Cohen SP, Gupta A, Strassels SA, et al. Effect of MRI 22272730. on treatment results or decision making in patients with lumbosacral radiculopathy referred for epidural Buchner M, Zeifang F, Brocai DR, et al. Epidural steroid injections: a multicenter, randomized corticosteroid injection in the conservative controlled trial. [Erratum appears in Arch Intern Med. management of sciatica. Clin Orthop Relat Res. 2000 2012 Apr 23;172(8):673]. Arch Intern Med. 2012 Jan Jun(375):149-56. PMID: 10853164. 23;172(2):134-42. PMID: 22157067. C-1 Appendix C. Included Studies Cohen SP, White RL, Kurihara C, et al. Epidural Gerszten PC, Smuck M, Rathmell JP, et al. Plasma steroids, etanercept, or saline in subacute sciatica: a disc decompression compared with fluoroscopy- multicenter, randomized trial. Ann Intern Med. 2012 guided transforaminal epidural steroid injections for Apr 17;156(8):551-9. PMID: 22508732. symptomatic contained lumbar disc herniation: a prospective, randomized, controlled trial. J Neurosurg Cuckler JM, Bernini PA, Wiesel SW, et al. The use of Spine. 2010 Apr;12(4):357-71. PMID: 20201654. epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study. J Ghahreman A, Bogduk N. Predictors of a favorable Bone Joint Surg Am. 1985 Jan;67(1):63-6. PMID: response to transforaminal injection of steroids in 3155742. patients with lumbar radicular pain due to disc herniation.
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