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Chronic Axial Spinal Pain and Facet Joint Interventions

ASIPP Guidelines

From Pain Physician Journal: Comprehensive Evidence-Based Guidelines for Facet Joint Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines Facet Joint Interventions 2020 Guidelines

 

BACKGROUND: Chronic axial spinal pain is one of the major causes of significant disability and health care costs, with facet joints as one of the proven causes of pain.

OBJECTIVE: To provide evidence-based guidance in performing diagnostic and therapeutic facet joint interventions.


METHODS: The methodology utilized included the development of objectives and key questions with utilization of trustworthy standards. The literature pertaining to all aspects of facet joint interventions, was reviewed, with a best evidence synthesis of available literature and utilizing grading for recommendations.

Summary of Evidence and Recommendations:
Non-interventional diagnosis:
• The level of evidence is II in selecting patients for facet joint nerve blocks at least 3 months after onset and failure of conservative management, with strong strength of recommendation for physical examination and clinical assessment.
• The level of evidence is IV for accurate diagnosis of facet joint pain with physical examination based on symptoms and signs, with weak strength of recommendation.

Imaging:
• The level of evidence is I with strong strength of recommendation, for mandatory fluoroscopic or computed tomography (CT) guidance for all facet joint interventions.
• The level of evidence is III with weak strength of recommendation for single photon emission computed tomography (SPECT) .
• The level of evidence is V with weak strength of recommendation for scintography, magnetic resonance imaging (MRI), and computed tomography (CT) .

Interventional Diagnosis:
Lumbar Spine:
• The level of evidence is I to II with moderate to strong strength of recommendation for lumbar diagnostic facet joint nerve blocks.
• Ten relevant diagnostic accuracy studies with 4 of 10 studies utilizing controlled comparative local anesthetics with concordant pain relief criterion standard of ? 80% were included.

CONCLUSION: These facet joint intervention guidelines were prepared with a comprehensive review of the literature with methodologic quality assessment with determination of level of evidence and strength of recommendations
 

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