Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain
Publication Date: February 1, 2019
Last Updated: March 14, 2022
Summary of Evidence
Lumbar Disc Injections:
Based on the available evidence regarding the use of platelet-rich plasma (PRP), including one high-quality randomized controlled trial (RCT), multiple moderate-quality observational studies, a single-arm meta-analysis and evidence from a systematic review, the qualitative evidence has been assessed as Level III (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best-evidence synthesis. (III, )
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Based on the available evidence regarding the use of medicinal signaling/ mesenchymal stem cell (MSCs) with a high-quality RCT, multiple moderate-quality observational studies, a single-arm meta-analysis, and 2 systematic reviews, the qualitative evidence has been assessed as Level III (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence-based on best evidence synthesis. (III, )
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Lumbar Epidural Injections:
Based on one high-quality RCT, multiple relevant moderate-quality observational studies and a single-arm meta-analysis, the qualitative evidence has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. (IV, )
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Lumbar Facet Joint Injections
Based on one high-quality RCT and 2 moderate-quality observational studies, the qualitative evidence for facet joint injections with PRP has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. (IV, )
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Sacroiliac Joint Injection:
Based on one high-quality RCT, one moderate-quality observational study, and one low-quality case report, the qualitative evidence has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. (IV, )
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Title
Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain
Authoring Organization
American Society of Interventional Pain Physicians
Publication Month/Year
February 1, 2019
Last Updated Month/Year
April 13, 2023
External Publication Status
Published
Country of Publication
US
Document Objectives
To provide guidance for the responsible, safe, and effective use of biologic therapy in the lumbar spine. To present a template on which to build standardized therapies using biologics. To ground potential administrators of biologics in the knowledge of the current outcome statistics and to stimulate those interested in providing biologic therapy to participate in high quality research that will ultimately promote and further advance this area of medicine.
Target Patient Population
Patients with low back pain
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Long term care, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Diseases/Conditions (MeSH)
D059350 - Chronic Pain, D001416 - Back Pain, D044968 - Regenerative Medicine, D058630 - Spinal Cord Regeneration
Keywords
biologics, chronic pain
Source Citation
Pain Physician: Guidelines Issue 2019; 22:S1-S74