PCA Deep Dive: When the Evidence Changes, Rethinking Spine Injections for Chronic Pain

PCA Deep Dive: When the Evidence Changes, Rethinking Spine Injections for Chronic PainThe Spinal Chat Podcast: PCA Deep Dive Series examines 2025 BMJ evidence on routine interventional procedures for chronic non-cancer spine pain and asks: When the evidence changes, should the way we deliver and pay for care change with it?A major BMJ systematic review and network meta-analysis included 132 eligible studies, with 81 randomized trials and 7,977 patients contributing to the quantitative analysis. It found that commonly used interventional procedures generally produced little to no clinically meaningful pain relief compared with sham procedures for chronic axial or radicular spine pain. A companion guideline issued strong recommendations against routine use, while interventional pain specialists have raised concerns about patient selection and responsive subgroups.The episode explores sham and contextual effects, regression to the mean, approximately $9 billion in annual U.S. spending on epidural injections, systemic incentives, and guideline-supported conservative care including exercise, education, self-management, rehabilitation, psychological approaches, and manual therapy.00:00 Welcome and Big Question01:42 Scope and Red Flags03:05 BMJ Review Breakdown06:30 Sham Effects Explained09:59 Specialist Backlash12:53 Nine Billion Economics13:55 How We Got Here17:44 Conservative Care Pathway20:25 Spinal Manipulation Role22:59 Policy and Self Advocacy24:57 Final Challenge and WrapKey SourcesWang X, Martin G, Sadeghirad B, et al. Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomized trials. BMJ. 2025;388:e079971. DOI: 10.1136/bmj-2024-079971Busse JW, Genevay S, Agarwal A, et al. Commonly used interventional procedures for non-cancer chronic spine pain: a clinical practice guideline. BMJ. 2025;388:e079970. DOI: 10.1136/bmj-2024-079970Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain. Ann Intern Med. 2017;166(7):514-530. DOI: 10.7326/M16-2367Ballantyne JC. Spinal interventions for chronic back pain: Do negative findings demand action? BMJ. 2025;388:r179. DOI: 10.1136/bmj.r179Pennsylvania Chiropractic Association www.pennchiro.org [email protected] and produced by Mike Barba for the Pennsylvania Chiropractic Association. AI-assisted tools were used in the production of this content. Final content was reviewed and approved by PCA.