Multiple injections for low back pain: What's the future?
Oluwatobi O Onafowokan1, Nicola F Fine2, Francis Brooks2
1Exeter Spine Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK. tonafowokan7@gmail.com.
Summary
Limited evidence supports multiple facet joint injections (FJIs) and medial branch blocks (MBBs) for low back pain. Current data show significant variation in FJI use, not backed by research.
Area of Science:
- Spinal interventions and evidence-based medicine.
Background:
- Facet joint injections (FJIs) and medial branch blocks (MBBs) are used for low back pain.
- The evidence supporting their efficacy, particularly for multiple procedures, requires examination.
Purpose of the Study:
- To assess the strength of evidence for multiple FJIs and MBBs.
- To analyze variations in their application within the NHS England framework using GIRFT data.
Main Methods:
- Systematic review adhering to the patient, intervention, comparison, outcome, and study (PICOS) strategy.
- Comprehensive literature search across Cochrane, MEDLINE, and EMBASE databases using specific MeSH terms.
Main Results:
- Only three studies investigated the efficacy of multiple FJIs or MBBs.
- None of the identified studies demonstrated sustained positive outcomes in long-term follow-up.
Conclusions:
- A significant lack of high-quality (Level I and II) evidence exists for multiple FJIs and MBBs in treating low back pain.
- Getting It Right First Time (GIRFT) data reveal considerable variability in multiple FJI utilization, which is not supported by current scientific literature.
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