Comprehensive Evidence-Based Guidelines for Facet Joint Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines
Background: Chronic axial spinal pain is one of the major causes of significant disability and health care costs, with facet joints as one of the proven causes of pain. Objective: To provide evidence-based guidance in performing diagnostic and therapeutic facet joint interventions. Methods: The meth...
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Published in | Pain physician Vol. 3S;23; no. 5;3S; pp. S1 - S127 |
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Main Author | |
Format | Journal Article |
Language | English |
Published |
14.05.2020
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Online Access | Get full text |
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Summary: | Background: Chronic axial spinal pain is one of the major causes of significant disability and
health care costs, with facet joints as one of the proven causes of pain.
Objective: To provide evidence-based guidance in performing diagnostic and therapeutic facet
joint interventions.
Methods: The methodology utilized included the development of objectives and key questions
with utilization of trustworthy standards. The literature pertaining to all aspects of facet joint
interventions, was reviewed, with a best evidence synthesis of available literature and utilizing
grading for recommendations.
Summary of Evidence and Recommendations:
Non-interventional diagnosis:
• The level of evidence is II in selecting patients for facet joint nerve blocks at least 3
months after onset and failure of conservative management, with strong strength of
recommendation for physical examination and clinical assessment.
• The level of evidence is IV for accurate diagnosis of facet joint pain with physical examination
based on symptoms and signs, with weak strength of recommendation.
Imaging:
• The level of evidence is I with strong strength of recommendation, for mandatory
fluoroscopic or computed tomography (CT) guidance for all facet joint interventions.
• The level of evidence is III with weak strength of recommendation for single photon
emission computed tomography (SPECT) .
• The level of evidence is V with weak strength of recommendation for scintography,
magnetic resonance imaging (MRI), and computed tomography (CT) .
Interventional Diagnosis:
Lumbar Spine:
• The level of evidence is I to II with moderate to strong strength of recommendation
for lumbar diagnostic facet joint nerve blocks.
• Ten relevant diagnostic accuracy studies with 4 of 10 studies utilizing controlled comparative
local anesthetics with concordant pain relief criterion standard of ≥ 80% were included.
• The prevalence rates ranged from 27% to 40% with false-positive rates of 27% to 47%, with
≥ 80% pain relief.Limitations: The limitations of these guidelines include a paucity of high-quality studies in the majority of aspects of diagnosis
and therapy.
Conclusions: These facet joint interventions guidelines were prepared with a comprehensive review of the literature with
methodologic quality assessment with determination of level of evidence and strength of recommendations
Key words: Chronic spinal pain, interventional techniques, diagnostic blocks, therapeutic interventions, facet joint nerve blocks,
intraarticular injections, radiofrequency neurolysis |
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ISSN: | 1533-3159 2150-1149 |
DOI: | 10.36076/ppj.2020/23/S1 |