Canadian evidence-based guidelines on spinal procedures for chronic pain.

INTRODUCTION

Interventional procedures are commonly used to diagnose and treat chronic pain of spinal origin but guidance on: their indications; frequency; technical conduct; requirements for image guidance; outcome measurement; and management of complications is lacking. These guidelines were developed by a Canadian group of clinicians, researchers, patient partners and representatives from provincial healthcare regulatory and funding bodies.

METHODS

Reviews of published literature were undertaken for commonly performed spinal procedures for pain, and the evidence was synthesised qualitatively. Evidence-based recommendations for each procedure were graded on a scale from A (strongest level) to D (not recommended), or as insufficient (I), using US Preventive Services Task Force criteria with the level of certainty rated as high, medium or low. All consensus recommendations required at least 75% agreement among the guideline panel. Good clinical practice statements were also developed.

RESULTS

We provide 15 key recommendations. The guidelines provide clinical practice recommendations and good clinical practice statements for procedures targeting chronic pain originating from the cervical, lumbar spine and sacroiliac joints. Clinical indications, evidence for efficacy and suggested frequency for repeated procedures have also been proposed.

DISCUSSION: These guidelines provide evidence-based recommendations and good clinical practice statements for performing diagnostic and therapeutic spinal interventions for chronic pain.