{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T06:35:35Z","timestamp":1793255735193,"version":"4.5.0"},"reference-count":78,"publisher":"BMJ","license":[{"start":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:00:00Z","timestamp":1739923200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2024,10,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To address the comparative effectiveness of common interventional procedures for chronic non-cancer (axial or radicular) spine pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>Medline, Embase, CINAHL, CENTRAL, and Web of Science from inception to 24 January 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study selection<\/jats:title>\n                    <jats:p>RCTs that enrolled patients with chronic non-cancer spine pain, randomised to receive a commonly used interventional procedure versus sham procedure, usual care, or another interventional procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>Pairs of reviewers independently identified eligible studies, extracted data, and assessed risk of bias. We conducted frequentist network meta-analyses to summarise the evidence and used the GRADE approach to rate the certainty of evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 132 eligible studies, 81 trials with 7977 patients that explored 13 interventional procedures or combinations of procedures were included in meta-analyses. All subsequent effects refer to comparisons with sham procedures. For chronic axial spine pain, the following probably provide little to no difference in pain relief (moderate certainty evidence): epidural injection of local anaesthetic (weighted mean difference (WMD) 0.28\u2009cm on a 10\u2009cm visual analogue scale (95% CI \u22121.18 to 1.75)), epidural injection of local anaesthetic and steroids (WMD 0.20 (\u22121.11 to 1.51)), and joint-targeted steroid injection (WMD 0.83 (\u22120.26 to 1.93)). Intramuscular injection of local anaesthetic (WMD \u22120.53 (\u22121.97 to 0.92)), epidural steroid injection (WMD 0.39 (\u22120.94 to 1.71)), joint-targeted injection of local anaesthetic (WMD 0.63 (\u22120.57 to 1.83)), and joint-targeted injection of local anaesthetic with steroids (WMD 0.22 (\u22120.42 to 0.87)) may provide little to no difference in pain relief (low certainty evidence); intramuscular injection of local anaesthetic with steroids may increase pain (WMD 1.82 (\u22120.29 to 3.93)) (low certainty evidence). Evidence for joint radiofrequency ablation proved of very low certainty.<\/jats:p>\n                    <jats:p>For chronic radicular spine pain, epidural injection of local anaesthetic and steroids (WMD \u22120.49 (\u22121.54 to 0.55)) and radiofrequency of dorsal root ganglion (WMD 0.15 (\u22120.98 to 1.28)) probably provide little to no difference in pain relief (moderate certainty evidence). Epidural injection of local anaesthetic (WMD \u22120.26 (\u22121.37 to 0.84)) and epidural injection of steroids (WMD \u22120.56 (\u22121.30 to 0.17)) may result in little to no difference in pain relief (low certainty evidence).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our NMA of randomised trials provides low to moderate certainty evidence that, compared with sham procedures, commonly performed interventional procedures for axial or radicular chronic non-cancer spine pain may provide little to no pain relief.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>PROSPERO (CRD42020170667)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2024-079971","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T20:00:18Z","timestamp":1739995218000},"page":"e079971","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":50,"title":["Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomised trials"],"prefix":"10.1136","volume":"388","author":[{"given":"Xiaoqin","family":"Wang","sequence":"first","affiliation":[{"name":"Michael G DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada"},{"name":"University of Ottawa Heart Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Behnam","family":"Sadeghirad","sequence":"additional","affiliation":[{"name":"Michael G DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaping","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan D","family":"Florez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Universidad de Antioquia, Medellin, Colombia"},{"name":"School of Rehabilitation Science, McMaster University, Hamilton, Canada."},{"name":"Pediatric Intensive Care Unit, Cl\u00ednica Las Americas, Medellin, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel J","family":"Couban","sequence":"additional","affiliation":[{"name":"Michael G DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Mehrabi","sequence":"additional","affiliation":[{"name":"HIV\/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran."},{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly N","family":"Crandon","sequence":"additional","affiliation":[{"name":"Michael G DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meisam Abdar","family":"Esfahani","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laxsanaa","family":"Sivananthan","sequence":"additional","affiliation":[{"name":"Graduate Entry Medical School, University of Limerick, Limerick, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Sengupta","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Kum","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"},{"name":"Michael G. 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