The objective of this review was to develop evidence-based recommendations on use of interventional diagnostic tests and therapies, surgeries, and interdisciplinary rehabilitation for low back pain of any duration, with or without leg pain. A multidisciplinary panel was convened by the American Pain Society. Its recommendations were based on a systematic review that focused on evidence from randomized controlled trials. Recommendations were graded using methods adapted from the US Preventive Services Task Force and the Grading of Recommendations, Assessment, Development, and Evaluation Working Group. Investigators reviewed 3348 abstracts. A total of 161 randomized trials were deemed relevant to the recommendations in this guideline. The panel developed a total of 8 recommendations.
Recommendations on use of interventional diagnostic tests and therapies, surgery, and interdisciplinary rehabilitation are presented. Due to important trade-offs between potential benefits, harms, costs, and burdens of alternative therapies, shared decision-making is an important component of a number of the recommendations.
Chou, Roger; Loeser, John D.; Owens, Douglas K.; Rosenquist, Richard W.; Atlas, Steven J.; Baisden, Jamie; Carragee, Eugene J.; Grabois, Martin; Murphy, Donald R.; Resnick, Daniel K.; Stanos, Steven P.; Shaffer, William O.; Wall, Eric M.; For the American Pain Society Low Back Pain Guideline Panel. Interventional Therapies, Surgery, and Interdisciplinary Rehabilitation for Low Back Pain: An Evidence-Based Clinical Practice Guideline From the American Pain Society. Spinr, 16 Oct 2009, online article ahead of print