Written by Babatunde Carew
Spoon Feed
This BMJ guideline strongly recommends against commonly used interventional procedures for non-cancer chronic spine pain due to low evidence of benefit and notable risks and burdens.
Shots fired – spine injections miss the mark
Chronic low back pain is highly prevalent, the leading cause of disability worldwide, and frequently resistant to first-line treatments. Chronic neck pain follows close behind as the fourth leading cause of disability. Many of these patients are referred for procedural interventions, but there is little evidence to support their effectiveness.
This BMJ guideline assessed the effectiveness and safety of interventional procedures for non-cancer-related chronic spine pain using a linked systematic review and network meta-analysis of 132 RCTs. Among patients with axial or radicular pain ≥3 months, procedures such as joint injections, epidural steroids, and radiofrequency ablation showed little to no benefit over sham, with moderate risk of adverse events. The panel issued strong recommendations against most interventions outside research settings. Future trials targeting subtypes of spine pain, exploring long-term effects, and examining more key patient outcomes are needed.
How does this change my practice?
As a PCP, I typically refer patients with chronic nonspecific spine pain to a specialty clinic after failed conservative therapy. Often a procedure (usually steroid injection) is offered. Given the limited effectiveness and notable burdens with most spinal interventions – adverse events, discomfort, lost productivity, and cost – more in-depth conversations with patients about such procedures are needed before sending them for subspecialty evaluation. The authors point out that when presented with a procedure of uncertain effectiveness with evidence of increased harm or burden, most people living with chronic spine pain would likely be disinclined to receive treatment.
Source
Commonly used interventional procedures for non-cancer chronic spine pain: a clinical practice guideline. BMJ. 2025 Feb 19;388:e079970. doi: 10.1136/bmj-2024-079970. PMID: 39971339
