What are other American Pain Society (APS) treatment guidelines for mechanical low back pain?

Updated: Mar 06, 2018
  • Author: Everett C Hills, MD, MS; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Evidence-based clinical practice guidelines from the American Pain Society (APS) for patients with chronic low back pain describe the use of interventional diagnostic tests and therapies, surgeries, and interdisciplinary rehabilitation. [35]

  • Practice guidelines for nonradicular pain

    • Interdisciplinary rehabilitation that emphasizes cognitive-behavioral approaches should be considered for patients who fail to respond to usual interventions.

    • Provocative diskography (in which material is injected into a disk nucleus to reproduce the patient's typical pain) is not recommended.

    • Facet joint corticosteroid injection, prolotherapy (stimulation of an inflammatory response through repeated injections of irritant material), and intradiskal corticosteroid injection are not recommended.

    • Degenerative spinal changes and persistent, disabling symptoms should lead to discussion and shared decision-making regarding surgery or interdisciplinary rehabilitation. (The evidence is insufficient to weigh the risks and benefits of vertebral disk replacement in these patients.)

  • Practice guidelines for persistent radiculopathy

    • For patients with herniated disks, the use of epidural steroid injection should be discussed. [36]

    • For patients with herniated disks and disabling leg pain from spinal stenosis, surgical options should be discussed.

    • For patients with persistent pain after surgery, the risks and benefits of spinal cord stimulation should be discussed.


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