Pain Management Injection Therapies for Low Back Pain

Technology Assessment

Pain Management Injection Therapies for Low Back Pain

Technology

Assessment Program

Prepared for:

Agency for Healthcare Research and Quality 540 Gaither Road Rockville, Maryland 20850

Final Original Publication: March 20, 2015

Revised Publication: July 10, 2015

Erratum

In Table 1 and Appendix E1, patient characteristics, number analyzed, and pain scores were edited to reflect 24 month followup data for one trial publication.1 In Table 1 and Appendix E1, a correction was made to note that imaging correlation was required for one trial (with two publications). 2, 3 The quality rating for this same trial was changed from fair to good in Table 1 to match the rating in Appendix E1.2, 3 These edits do not affect the report conclusions.

References

1.

Manchikanti L, Singh V, Cash KA, Pampati V, Falco FJ. A randomized, double-blind, active-control trial

of the effectiveness of lumbar interlaminar epidural injections in disc herniation. Pain Physician.

2014;17(1):E61-74. PMID: 24452658.

2. Ghahreman A, Ferch R, Bogduk N. The efficacy of transforaminal injection of steroids for the treatment of

lumbar radicular pain. Pain Med. 2010 Aug;11(8):1149-68. PMID: 20704666.

3.

Ghahreman A, Bogduk N. Predictors of a favorable response to transforaminal injection of steroids in

patients with lumbar radicular pain due to disc herniation. Pain Med. 2011;12(6):871-9. PMID: 21539702.

i

Pain Management Injection Therapies for Low Back Pain

Technology Assessment Report 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

ii

This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290-2012-00014-I). The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decision-makers; patients and clinicians, health system leaders, and policymakers, make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies may not be stated or implied.

This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated.

Persons using assistive technology may not be able to fully access information in this report. For assistance contact TAP@ahrq.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

Suggested citation. Chou R, Hashimoto R, Friedly J, Fu Rochelle, Dana T, Sullivan S, Bougatsos C, Jarvik J. Pain Management Injection Therapies for Low Back Pain. Technology Assessment Report ESIB0813. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. HHSA 290-2012-00014-I.) Rockville, MD: Agency for Healthcare Research and Quality; July 2015.

iii

Acknowledgments

We thank Rebecca Holmes, M.D., Ian Blazina M.P.H., and Alex Ginsburg, M.A., M.C.R.P. for assistance with data abstraction; Sara Grusing, B.A., for assistance with the EndNote library; and Leah Williams, B.S., for editorial support; Oregon Health and Science University.

Key Informants

In designing the study questions, the Evidence-based Practice Center (EPC) consulted several Key Informants who represent the end-users of research. The EPC sought the Key Informant input on the priority areas for research and synthesis. Key Informants are not involved in the analysis of the evidence or the writing of the report. Therefore, in the end, study questions, design, methodological approaches, and/or conclusions do not necessarily represent the views of individual Key Informants.

Key Informants must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their role as end-users, individuals with potential conflicts may be retained. The Task Order Officer and the EPC work to balance, manage, or mitigate any conflicts of interest. The list of Key Informants who participated in developing this report follows:

Charles Argoff, M.D. Professor of Neurology, Albany Medical College Director, Comprehensive Pain Center, Albany Medical Center Albany, NY

John Carrino, M.D., M.P.H. Associate Professor, Russell H. Morgan Department of Radiology and Radiological Science ; Associate Professor, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine Section Chief, Musculoskeletal Radiology, Johns Hopkins Hospital Baltimore, M.D.

Steven Cohen, M.D. Professor, Departments of Anesthesiology & Critical Care Medicine & Physical Medicine & Rehabilitation Director, Blaustein Pain Treatment Center Johns Hopkins School of Medicine Baltimore, MD Professor, Department of Anesthesiology & Physical Medicine & Rehabilitation Uniformed Services University of the Health Sciences Bethesda, MD

Penney Cowan Executive Director, American Chronic Pain Association Rocklin, CA

iv

Richard Deyo, M.D., M.P.H. Professor, Family Medicine, Department of Medicine, Department of Public Health and Preventive Medicine, Center for Research in Occupational and Environmental Toxicology/School of Medicine, Oregon Health and Science University Portland, OR

Gary Franklin, M.D., M.P.H. Medical Director, Washington State Department of Labor and Industries Chair, Washington Agency Medical Director's Group Research Professor, Departments of Environmental and Occupational Health Sciences, Neurology, and Health Services, University of Washington Seattle, Washington

Mary Scott, B.A. Patient Representative Thorp, WA

Steven Stanos, D.O. Associate Professor, Department of Physical Medicine and Rehabilitation; Assistant Program Director, Multidisciplinary Pain Fellowship

Northwestern University Medical School,

Feinberg School of Medicine Chicago, IL

Technical Expert Panel

In place of a Technical Expert Panel, CMS provided input to the Key Questions and scope of the report.

Peer Reviewers

Prior to publication of the final evidence report, the EPC sought input from independent Peer Reviewers without financial conflicts of interest. However, the conclusions and synthesis of the scientific literature presented in this report does not necessarily represent the views of individual reviewers.

Peer Reviewers must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential non-financial conflicts may be retained. The Task Order Officer and the EPC work to balance, manage, or mitigate any potential non-financial conflicts of interest identified.

The list of Peer Reviewers follows:

v

Charles Argoff, M.D. Professor of Neurology, Albany Medical College Director, Comprehensive Pain Center, Albany Medical Center Albany, NY

Steven Cohen, M.D. Professor, Departments of Anesthesiology & Critical Care Medicine & Physical Medicine & Rehabilitation Director, Blaustein Pain Treatment Center Johns Hopkins School of Medicine Baltimore, MD Professor, Department of Anesthesiology & Physical Medicine & Rehabilitation Uniformed Services University of the Health Sciences Bethesda, MD

Gilbert Fanciullo, M.D., M.S. Director, Section of Pain Medicine Dartmouth Hitchcock Medical Center Professor, Geisel School of Medicine at Dartmouth Hanover, NH

Gary Franklin, M.D., M.P.H. Medical Director, Washington State Department of Labor and Industries Chair, Washington Agency Medical Director's Group Research Professor, Departments of Environmental and Occupational Health Sciences, Neurology, and Health Services, University of Washington Seattle, Washington

Martin Grabois, M.D. Professor for Physical Medicine and Rehabilitation Baylor College Medical Center Houston, TX

Erin E. Krebs, M.D., M.P.H. Women's Health Medical Director, Minneapolis VA Health Care System; Associate Professor, Department of Medicine, University of Minnesota, Minneapolis, MN

Timothy Maus, M.D. Associate Professor of Radiology Mayo Clinic Rochester, Minnesota, USA

Mark Wallace, M.D. Chair, Division of Pain Medicine; Professor of Clinical Anesthesiology University of California, San Diego San Diego, CA

vi

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download