Injection Therapy for Subacute and Chronic Low Back Pain: An Updated Cochrane Review

@article{Staal2009InjectionTF,
  title={Injection Therapy for Subacute and Chronic Low Back Pain: An Updated Cochrane Review},
  author={J. Bart Staal and Rob A. de Bie and Henrica C. W. de Vet and Jan Hildebrandt and Patricia J. Nelemans},
  journal={Spine},
  year={2009},
  volume={34},
  pages={49-59}
}
Study Design. A systematic review of randomized controlled trials (RCTs). Objective. To determine if injection therapy is more effective than placebo or other treatments for patients with subacute or chronic low back pain. Summary of Background Data. The effectiveness of injection therapy for low back pain is still debatable. Heterogeneity of target tissue, pharmacological agent, and dosage, generally found in RCTs, point to the need for clinically valid comparisons in a literature synthesis… 
Injection therapy for subacute and chronic low-back pain.
TLDR
There is insufficient evidence to support the use of injection therapy in subacute and chronic low-back pain, however, it cannot be ruled out that specific subgroups of patients may respond to a specific type of injection Therapy.
Injection therapy and denervation procedures for chronic low-back pain: a systematic review
TLDR
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.
EPIDURAL STEROID INJECTION THERAPY FOR LOW BACK PAIN: A META-ANALYSIS
  • H. Choi, S. Hahn, B. Park
  • Medicine
    International Journal of Technology Assessment in Health Care
  • 2013
TLDR
A long-term benefit of epidural steroid injections for low back pain was not suggested at 6 months or longer, and introduction of selection bias in the majority of injection studies seems apparent.
Ozone therapy as a treatment for low back pain secondary to herniated disc: a systematic review and meta-analysis of randomized controlled trials.
TLDR
Ozone therapy appears to yield positive results and low morbidity rates when applied percutaneously for the treatment of chronic low back pain.
Intra-articular facet joint injections for low back pain: a systematic review
TLDR
The positive results, whilst interpreted with caution, do suggest that there is a need for further high-quality work in this area, and a number of methodological issues were identified.
Epidural Injections for Spinal Pain: A Systematic Review and Meta-analysis Evaluating the “Control” Injections in Randomized Controlled Trials
TLDR
Epidural nonsteroid injections may provide improved benefit compared with nonepidural injections on some measures, though few, low-quality studies directly compared controlled treatments, and only short-term outcomes were examined.
Effect of Facet Joint Injection Versus Systemic Steroids in Low Back Pain: A Randomized Controlled Trial
TLDR
Both treatments were effective, with a slight superiority of the intra-articular injection of steroids over intramuscular injection.
Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial.
TLDR
This feasibility study achieved consensus on the main challenges in a trial of FJIs for people with persistent non-specific low back pain, and process data illuminate some of the reasons for recruitment problems but also show that trial processes after enrolment ran smoothly.
Comparative Effectiveness Review of Cooled Versus Pulsed Radiofrequency Ablation for the Treatment of Knee Osteoarthritis: A Systematic Review.
TLDR
Overall, the studies showed promising results for the treatment of severe chronic knee pain by radiofrequency ablation at up to one year with minimal complications, but the inconsistent procedural methodology, inconsistent patient assessment measures, and small study sizes limit the applicability of any specific study to clinical practice.
Epidural Steroids: A Comprehensive, Evidence-Based Review
TLDR
Epidural steroid injections are the most widely utilized pain management procedure in the world, their use supported by more than 45 placebo-controlled studies and dozens of systematic reviews, but there continues to be considerable controversy surrounding their safety and efficacy.
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