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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Recommendation Grading

Overview

Title

Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain

Authoring Organization

Publication Month/Year

February 1, 2019

Last Updated Month/Year

April 13, 2023

Supplemental Implementation Tools

Document Type

Guideline

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

Scope

Treatment

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

Supplemental Methodology Resources

Systematic Review Document