Open AccessA Critical Review of the American Pain Society Clinical Practice Guidelines for Interventional Techniques: Part 1. Diagnostic Interventions
Author(s) -
Laxmaiah Manchikanti,
Sukdeb Datta,
Richard Derby,
Lee R. Wolfer,
Ramsin Benyamin,
Joshua A Hirsch
Publication year - 2010
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2010/13/e141
Subject(s) - medicine , guideline , psychological intervention , interventional pain management , low back pain , systematic review , health care , evidence based medicine , medline , facet joint , evidence based practice , alternative medicine , physical therapy , chronic pain , nursing , lumbar , pathology , surgery , economic growth , political science , law , economics
Background: Clinical guidelines are defined as systematically developed statementsto assist practitioner and patient decisions about appropriate health care for specificclinical circumstances. The clinical guideline industry has been erupting even fasterthan innovation in health care, constantly adding unhealthy perspectives with broadand complex mandates to health care interventions. Clinical guidelines are based onevidence-based medicine (EBM) and comparative effectiveness research (CER).Multiple issues related to the development of clinical guidelines are based on conflicts ofinterest, controversies, and limitations of the guideline process. Recently, the AmericanPain Society (APS) developed and published multiple guidelines in managing low backpain resulting in multiple publications. However, these guidelines have been questionedregarding their development process, their implementation, and their impact on variousspecialties.Objectives: To reassess the APS guidelines’ evidence synthesis for low back paindiagnostic interventions using the same methodology utilized by the APS authors. Theinterventions examined were diagnostic techniques for managing low back pain of facetjoint origin, discogenic origin, and sacroiliac joint origin.Methods: A literature search by two authors was carried out utilizing appropriatedatabases from 1966 through July 2008. Methodologic quality assessment was alsoperformed by at least 2 authors utilizing the same criteria applied in APS guidelines.The guideline reassessment process included the evaluation of individual studies andsystematic reviews and the translation into practice recommendations.Results: Our reassessment of Chou et al’s evaluation, utilizing Chou et al’s criteria,showed good evidence for lumbar facet joint nerve blocks, fair evidence for lumbarprovocation discography, and fair to poor evidence for sacroiliac joint blocks to diagnosesacroiliac joint pain. The reassessment illustrates that Chou et al have utilized multiplestudies inappropriately and have excluded appropriate studies. Also, Chou et al failed toeliminate their bias in their study evaluations.Conclusion: The reassessment, using appropriate methodology and including highquality studies, shows evidence that differs from published APS guidelines.Key words: Guidelines, evidence-based medicine, comparative effectivenessresearch, systematic reviews, American Pain Society, interventional pain management,interventional techniques, low back pain, diagnostic interventions, lumbar facet jointnerve blocks, lumbar provocation discography, sacroiliac joint nerve blocks