Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group.

Autor:	Cohen SP; Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA scohen40@jhmi.edu., Bhaskar A; Anesthesiology, Imperial College Healthcare NHS Trust Haemodialysis Clinic Hayes Satellite Unit, Hayes, UK., Bhatia A; Anesthesia and Pain Management, University of Toronto and University Health Network-Toronto Western Hospital, Toronto, Ontario, Canada., Buvanendran A; Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA., Deer T; Spine & Nerve Centers, Charleston, West Virginia, USA., Garg S; Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Hooten WM; Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA., Hurley RW; Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Kennedy DJ; Physical Medicine & Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., McLean BC; Anesthesiology, Tripler Army Medical Center, Tripler Army Medical Center, Hawaii, USA., Moon JY; Dept of Anesthesiology, Seoul National University College of Medicine, Seoul, The Republic of Korea., Narouze S; Center for Pain Medicine, Summa Western Reserve Hospital, Cuyahoga Falls, Ohio, USA., Pangarkar S; Dept of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA., Provenzano DA; Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, USA., Rauck R; Carolinas Pain Institute, Winston Salem, North Carolina, USA., Sitzman BT; Advanced Pain Therapy, Hattiesburg, Mississippi, USA., Smuck M; Dept.of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, Stanford Medicine, Stanford, California, USA., van Zundert J; Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Belgium.; Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands., Vorenkamp K; Anesthesiology, Duke Medicine, Durham, North Carolina, USA., Wallace MS; Anesthesiology, UCSD Medical Center-Thornton Hospital, San Diego, California, USA., Zhao Z; Neurology, VA Healthcare Center District of Columbia, Washington, District of Columbia, USA.
Jazyk:	angličtina
Zdroj:	Regional anesthesia and pain medicine [Reg Anesth Pain Med] 2020 Jun; Vol. 45 (6), pp. 424-467. Date of Electronic Publication: 2020 Apr 03.
DOI:	10.1136/rapm-2019-101243
Abstrakt:	Background: The past two decades have witnessed a surge in the use of lumbar facet blocks and radiofrequency ablation (RFA) to treat low back pain (LBP), yet nearly all aspects of the procedures remain controversial. Methods: After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, letters were sent to a dozen pain societies, as well as representatives from the US Departments of Veterans Affairs and Defense. A steering committee was convened to select preliminary questions, which were revised by the full committee. Questions were assigned to 4-5 person modules, who worked with the Subcommittee Lead and Committee Chair on preliminary versions, which were sent to the full committee. We used a modified Delphi method, whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chair, who incorporated the comments and sent out revised versions until consensus was reached. Results: 17 questions were selected for guideline development, with 100% consensus achieved by committee members on all topics. All societies except for one approved every recommendation, with one society dissenting on two questions (number of blocks and cut-off for a positive block before RFA), but approving the document. Specific questions that were addressed included the value of history and physical examination in selecting patients for blocks, the value of imaging in patient selection, whether conservative treatment should be used before injections, whether imaging is necessary for block performance, the diagnostic and prognostic value of medial branch blocks (MBB) and intra-articular (IA) injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for a prognostic block, how many blocks should be performed before RFA, how electrodes should be oriented, the evidence for larger lesions, whether stimulation should be used before RFA, ways to mitigate complications, if different standards should be applied to clinical practice and clinical trials and the evidence for repeating RFA (see table 12 for summary). Conclusions: Lumbar medial branch RFA may provide benefit to well-selected individuals, with MBB being more predictive than IA injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of more false-negatives. Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice. Competing Interests: Competing interests: TD: consultant for Abbott, Axonics, Nalu, Saluda, Medtronic, Vertiflex (Boston Scientific), Nevro, Vertos, Vertiflex, SPR. Funded research: Vertiflex, Vertos, Abbott, Saluda, SPR. Minor Equity: Bioness, Vertiflex, Vertos, Saluda, SPR. SPC: funded research: Avanos Consultant: Abbott, Medtronic, Boston Scientific David Provenzano: consultant for Avanos, Boston Scientific, Medtronic, Nevro, Esteve and Salix Research support: Medtronic, Nevro, Stimgenics and Abbott. (© American Society of Regional Anesthesia & Pain Medicine 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.)
Databáze:	MEDLINE
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