The Wrong Way to Treat Chronic Spine Pain

The BMJ, formerly the British Medical Journal, has issued a strong recommendation against several commonly used interventional procedures for non-cancer chronic spine pain. This "Rapid Recommendation" advises against joint radiofrequency ablation, epidural injections, joint-targeted injections, and intramuscular injections for chronic axial spine pain, as well as dorsal root ganglion radiofrequency and epidural injections for chronic radicular spine pain. The recommendation, based on a clinical practice guideline developed by an international expert panel, suggests that "all or nearly all well-informed people would likely not want such interventions" and that they should primarily be offered within clinical trials. This expert panel, comprised of patients, clinicians, and methodologists, based their guideline on systematic reviews and meta-analyses of existing research. An accompanying article in the BMJ highlights the significant cost burden of these often ineffective treatments, citing an estimated $9 billion spent annually on epidural injections in the U.S.. While these injections might offer relief for acute and subacute pain, they are often problematic for chronic pain. This new guideline signals a potential shift in how chronic spine pain is managed, emphasizing the need to reconsider the widespread use of these interventional procedures.