PMID- 19668292
OWN - NLM
STAT- MEDLINE
DCOM- 20091030
LR  - 20130715
IS  - 2150-1149 (Electronic)
IS  - 1533-3159 (Linking)
VI  - 12
IP  - 4
DP  - 2009 Jul-Aug
TI  - Comprehensive review of neurophysiologic basis and diagnostic interventions in 
      managing chronic spinal pain.
PG  - E71-120
AB  - BACKGROUND: Understanding the neurophysiological basis of chronic spinal pain and 
      diagnostic interventional techniques is crucial in the proper diagnosis and 
      management of chronic spinal pain. Central to the understanding of the structural 
      basis of chronic spinal pain is the provision of physical diagnosis and 
      validation of patient symptomatology. It has been shown that history, physical 
      examination, imaging, and nerve conduction studies in non-radicular or discogenic 
      pain are unable to diagnose the precise cause in 85% of the patients. In 
      contrast, controlled diagnostic blocks have been shown to determine the cause of 
      pain in as many as 85% of the patients. OBJECTIVE: To provide evidence-based 
      clinical practice guidelines for diagnostic interventional techniques. DESIGN: 
      Best evidence synthesis. METHODS: Strength of evidence was assessed by the U.S. 
      Preventive Services Task Force (USPSTF) criteria utilizing 5 levels of evidence 
      ranging from Level I to III with 3 subcategories in Level II. DIAGNOSTIC 
      CRITERIA: Diagnostic criteria established by systematic reviews were utilized 
      with controlled diagnostic blocks. Diagnostic criteria included at least 80% pain 
      relief with controlled local anesthetic blocks with the ability to perform 
      multiple maneuvers which were painful prior to the diagnostic blocks for facet 
      joint and sacroiliac joint blocks, whereas for provocation discography, the 
      criteria included concordant pain upon stimulation of the target disc with 2 
      adjacent discs producing no pain at all. RESULTS: The indicated level of evidence 
      for diagnostic lumbar, cervical, and thoracic facet joint nerve blocks is Level I 
      or II-1. The indicated evidence is Level II-2 for lumbar and cervical 
      discography, whereas it is Level II-3 for thoracic provocation discography. The 
      evidence for diagnostic sacroiliac joint nerve blocks is Level II-2. Level of 
      evidence for selective nerve root blocks for diagnostic purposes is Level II-3. 
      LIMITATIONS: Limitations of this guideline preparation include a continued 
      paucity of literature and conflicts in preparation of systematic reviews and 
      guidelines. CONCLUSION: These guidelines include the evaluation of evidence for 
      diagnostic interventional procedures in managing chronic spinal pain and 
      recommendations. However, these guidelines do not constitute inflexible treatment 
      recommendations. These guidelines also do not represent a "standard of care."
FAU - Manchikanti, Laxmaiah
AU  - Manchikanti L
AD  - Pain Management Center of Paducah, Paducah, KY, USA. drlm@thepainmd.com
FAU - Boswell, Mark V
AU  - Boswell MV
FAU - Singh, Vijay
AU  - Singh V
FAU - Derby, Richard
AU  - Derby R
FAU - Fellows, Bert
AU  - Fellows B
FAU - Falco, Frank J E
AU  - Falco FJ
FAU - Datta, Sukdeb
AU  - Datta S
FAU - Smith, Howard S
AU  - Smith HS
FAU - Hirsch, Joshua A
AU  - Hirsch JA
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Pain Physician
JT  - Pain physician
JID - 100954394
SB  - IM
MH  - Chronic Disease
MH  - Cost-Benefit Analysis
MH  - *Evidence-Based Medicine
MH  - Humans
MH  - Nerve Block/methods
MH  - *Neurophysiology
MH  - *Pain/complications/diagnosis
MH  - Pain Management
MH  - Pain Measurement
MH  - Practice Guidelines as Topic
MH  - Randomized Controlled Trials as Topic
MH  - Severity of Illness Index
MH  - Spinal Cord Injuries/*complications/diagnosis/therapy
MH  - Spine/pathology
MH  - Treatment Outcome
MH  - Zygapophyseal Joint/pathology/physiopathology
RF  - 788
EDAT- 2009/08/12 09:00
MHDA- 2009/10/31 06:00
CRDT- 2009/08/12 09:00
PHST- 2009/08/12 09:00 [entrez]
PHST- 2009/08/12 09:00 [pubmed]
PHST- 2009/10/31 06:00 [medline]
PST - ppublish
SO  - Pain Physician. 2009 Jul-Aug;12(4):E71-120.