title: Injection therapy and denervation procedures for chronic low-back pain: a systematic review.
abstract: Injection therapy and denervation procedures are commonly used in the management of chronic low-back pain (LBP) despite uncertainty regarding their effectiveness and safety. To provide an evaluation of the current evidence associated with the use of these procedures, a systematic review was performed. Existing systematic reviews were screened, and the Cochrane Back Review Group trial register was searched for randomized controlled trials (RCTs) fulfilling the inclusion criteria. Studies were included if they recruited adults with chronic LBP, evaluated the use of injection therapy or denervation procedures and measured at least one clinically relevant outcome (such as pain or functional status). Two review authors independently assessed studies for eligibility and risk of bias (RoB). A meta-analysis was performed with clinically homogeneous studies, and the GRADE approach was used to determine the quality of evidence. In total, 27 RCTs were included, 14 on injection therapy and 13 on denervation procedures. 18 (66%) of the studies were determined to have a low RoB. Because of clinical heterogeneity, only two comparisons could be pooled. Overall, there is only low to very low quality evidence to support the use of injection therapy and denervation procedures over placebo or other treatments for patients with chronic LBP. However, it cannot be ruled out that in carefully selected patients, some injection therapy or denervation procedures may be of benefit.
authors.affiliation: The George Institute for International Health, Sydney, Australia. n.henschke@vumc.nl
authors.forename: Nicholas
authors.initials: N
authors.lastname: Henschke
authors.forename: Ton
authors.initials: T
authors.lastname: Kuijpers
authors.forename: Sidney M
authors.initials: SM
authors.lastname: Rubinstein
authors.forename: Marienke
authors.initials: M
authors.lastname: van Middelkoop
authors.forename: Raymond
authors.initials: R
authors.lastname: Ostelo
authors.forename: Arianne
authors.initials: A
authors.lastname: Verhagen
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Maurits W
authors.initials: MW
authors.lastname: van Tulder
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D002908:Chronic Disease; D002917:Chymopapain / Q000008:administration & dosage; D003714:Denervation / Q000379:methods; D006801:Humans; D007268:Injections, Epidural; D007270:Injections, Intra-Articular; D007273:Injections, Intramuscular; D017116:Low Back Pain / Q000188:drug therapy* / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local; D002917:Chymopapain