Clinical Practice Guidelines on Interventional Management of Low Back Pain: A Synthesis of Recommendations

Abstract

Objective: To summarize the recommendations on the interventional management of subacute and chronic non-radicular low back pain (LBP) from the 21 quality-appraised CPGs identified in the previously published paper: "Quality of Clinical Practice Guidelines on Interventional Management of Low Back Pain: A Systematic Review". By disseminating this information, we aim to facilitate the implementation of these recommendations into clinical practice.

Literature survey: Electronic bibliographic databases, guideline databases and grey literature were searched from January 2016 to January 2020 to identify CPGs that met study criteria.

Methodology: 21 CPGs were quality-appraised and interventional management recommendations were extracted and organized into several treatment categories including epidural steroid injections (ESIs), radiofrequency procedures (RF), facet injections, sacroiliac injections (SI), and prolotherapy. Within each treatment category, the recommendations were organized based on 2 factors: quality of CPG and strength of recommendation.

Synthesis: Overall, there was no consistency in recommendations for or against any interventional procedure, even when accounting for the quality of the CPG. In all of the CPGs reviewed, the most common strength of recommendation was weakly-for. The second, third and fourth most common strength of recommendations were inconclusive, weakly-against and strongly-against respectively and the least common was strongly-for. The treatment categories with the greatest number of recommendations were RF procedures (most common strength of recommendation-weakly for) and facet procedures. Among the high-quality CPGs, the most common strength of recommendation was inconclusive.

Conclusions: Most of the interventional management recommendations for management of non-radicular LBP in the 21 CPGs appraised in this review were either weakly-for, weakly-against or inconclusive, with several recommendations within each treatment category contradicting each other. AGREE II quality appraisals of CPGs on interventional management of LBP were of unclear utility in guiding clinical implementation.