The Wrong Way to Treat Chronic Spine Pain

Breaking news for chronic spine pain patients and providers: the latest "Rapid Recommendation" from the BMJ strongly advises against several commonly used interventional procedures for chronic spine pain not caused by cancer or inflammatory conditions. An international expert panel, basing their guideline on systematic reviews of trials, concluded that "all or nearly all well-informed people would likely not want such interventions".The specific procedures now strongly recommended against include various types of injections like joint radiofrequency ablation, epidural injections (with local anesthetic, steroids, or both), joint-targeted injections, and intramuscular injections for chronic axial spine pain. For chronic radicular spine pain, dorsal root ganglion radiofrequency with or without epidural injection is also not recommended.This significant shift highlights concerns that these methods, while potentially effective for acute pain, are often ineffective for chronic pain and pose a substantial financial burden on healthcare systems, costing billions annually in the U.S. alone. These procedures should now typically only be considered within the context of a clinical trial.