| chronic pain

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
 

Access the journal.

Sign Up

Subscribe to the PAINWeek Newsletter
and get our latest articles and more directly in your inbox.