Interventional Therapies, Surgery, and Interdisciplinary
Rehabilitation for Low Back Pain: An Evidence-based
Clinical Practice Guideline From
the American Pain Society

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   Spine (Phila Pa 1976). 2009 (May 1);   34 (10):   1066–1077

Chou, Roger MD; Loeser, John D. MD; Owens, Douglas K. MD, MS;
Rosenquist, Richard W. MD; Atlas, Steven J. MD, MPH; Baisden, Jamie MD, FACS;
Carragee, Eugene J. MD; Grabois, Martin MD; Murphy, Donald R. DC, DACAN;
Resnick, Daniel K. MD; Stanos, Steven P. DO; Shaffer, William O. MD;
Wall, Eric M. MD, MPH;
For the American Pain Society Low Back Pain Guideline Panel

Department of Medicine,
Oregon Evidence-based Practice Center,
Oregon Health and Science University,
Portland, OR, USA.
chour@ohsu.edu

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Review the complete Guideline for the Evaluation and Management of Low Back Pain: Evidence Review (482 page Adobe Acrobat file)

STUDY DESIGN:   Clinical practice guideline.

OBJECTIVE:   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.

SUMMARY OF BACKGROUND DATA:   Management of patients with persistent and disabling low back pain remains a clinical challenge. A number of interventional diagnostic tests and therapies and surgery are available and their use is increasing, but in some cases their utility remains uncertain or controversial. Interdisciplinary rehabilitation has also been proposed as a potentially effective noninvasive intervention for persistent and disabling low back pain.

METHODS:   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.

RESULTS:   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.

CONCLUSION:   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.

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