Epidural Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Comprehensive Evidence-Based Guidelines

BACKGROUND: Chronic spinal pain is the most prevalent chronic disease with employment of multiple modes interventional techniques including epidural interventions. Multiple randomized controlled trials (RCTs), observational studies, systematic reviews, and guidelines have been published. The recent review utilization patterns expenditures show that there has a decline in injections decrease inflation adjusted costs from 2009 to 2018. American Society Interventional Pain Physicians (ASIPP) published for 2013, facet joint interventions 2020. Consequently, these prepared update previously existing guidelines. OBJECTIVE: To provide evidence-based guidance performing therapeutic procedures, caudal, interlaminar lumbar, cervical, thoracic regions, transforaminal lumbar spine, percutaneous adhesiolysis spine. METHODS: methodology utilized included development objective key questions trustworthy standards. literature pertaining all aspects was viewed best evidence synthesis available recommendations were provided. RESULTS: In preparation guidelines, extensive performed. addition manuscripts reference utilization, expenditures, anatomical pathophysiological considerations, pharmacological harmful effects drugs we 47 reviews 43 RCTs covering meet objectives. are as follows: Disc herniation: Based on relevant, high-quality fluoroscopically guided injections, or without steroids, results previous Level I caudal cervical strong recommendation long-term effectiveness. managing disc herniation based one high-quality, placebo-controlled RCT II moderate improvement patients nonresponsive conservative management injections. For herniation, fluoroscopic guidance, Spinal stenosis: each category III IV improvement. stenosis high quality RCTs, after failure Axial discogenic pain: axial sacroiliac spine relevant improvement, steroids. Post-surgery syndrome: post-surgery syndrome adhesiolysis, LIMITATIONS: limitations include continued paucity studies some various conditions stenosis, syndrome, pain. CONCLUSIONS: These intervention comprehensive methodologic assessment determination level strength recommendations. KEY WORDS: pain, techniques, epidural, DISCLAIMER: do not constitute inflexible treatment Due changing body evidence, this document intended be “standard care.” There no external funding manuscript.