Summary of Evidence

Document Overview

Design and created by Guideline Central in participation with the American Society of Interventional Pain Physicians.

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

American Society of Interventional Pain Physicians

Publication Date: Feb 1, 2019

Page Last Updated: May 5, 2026

American Society of Interventional Pain Physicians Grading System

Level	Quality of Evidence	Definition
I	Strong	Evidence obtained from multiple relevant high quality randomized controlled trials or Evidence obtained from multiple high quality diagnostic accuracy studies
II	Moderate	Evidence obtained from at least one relevant high quality randomized controlled trial or multiple relevant moderate or low quality randomized controlled trials or Evidence obtained from at least one high quality diagnostic accuracy study or multiple moderate or low quality diagnostic accuracy studies
III	Fair	Evidence obtained from at least one relevant moderate or low quality randomized controlled trial study or Evidence obtained from at least one relevant high quality non-randomized trial or observational study with multiple moderate or low quality observational studies or Evidence obtained from at least one moderate quality diagnostic accuracy study in addition to low quality studies
IV	Limited	Evidence obtained from multiple moderate or low quality relevant observational studies or Evidence obtained from multiple relevant low quality diagnostic accuracy studies
V	Consensus- based	Opinion or consensus of large group of clinicians and/or scientists

Grade	Strength of recommendation
Strong	There is high confidence that the recommendation reflects best practice. This is based on: a) strong evidence for a true net effect (e.g., benefits exceed harms); b) consistent results, with no or minor exceptions; c) minor or no concerns about study quality; and/or d) the extent the panelists’ agreement. Other compelling considerations (discussed in the guideline’s literature review and analyses) may also warrant a strong recommendation.
Moderate	There is moderate confidence that the recommendation reflects best practice. This is based on: a) good evidence for a true net effect (e.g. benefits exceed harms); b) consistent results, with minor and/or few exceptions; c) minor and/or few concerns about study quality; and/or d) the extent of panelists’ agreement. Other compelling considerations (discussed in the guideline’s literature review and analyses) may also warrant a moderate recommendation.
Weak	There is some confidence that the recommendation offers the best current guidance for practice. This is based on: a) limited evidence for a true net effect (e.g., benefits exceed harms); b) consistent results, but with important exceptions; c) concerns about study quality; and/or d) the extent of panelists’ agreement. Other considerations (discussed in the guideline’s literature review and analyses) may also warrant a weak recommendation.

Document Overview

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

Authoring Society: American Society of Interventional Pain Physicians

Document Publication Date: Feb 1, 2019

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.painphysicianjournal.com/current/pdf?article=NjEwMQ%3D%3D&journal=118

Source Citation: Pain Physician: Guidelines Issue 2019; 22:S1-S74

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

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.

Scope: Treatment

Diseases/Conditions (MeSH)

D059350 - Chronic Pain

D001416 - Back Pain

D044968 - Regenerative Medicine

D058630 - Spinal Cord Regeneration

D059350 - Chronic Pain

D001416 - Back Pain

D044968 - Regenerative Medicine

D058630 - Spinal Cord Regeneration

Keywords: biologics, chronic pain

Target Patient Population: patients with low back pain

Inclusion Criteria: Male, Female, Adolescent, Adult, Older Adult

Health Care Settings: Ambulatory, Hospital, Long Term Care, Outpatient

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resource: Systematic Review Document

Number of Source Documents: 353

Literature Search End Date: Saturday, June 30, 2018

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Identifies study selection process?: Yes

Identifies study selection criteria?: Yes

Identifies methods used to evaluate and analyze the evidence?: Yes

Identifies key questions addressed by the systematic review?: Yes

Identifies search strategy?: Yes

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

Summary of Evidence

Lumbar Disc Injections:

Lumbar Epidural Injections:

Lumbar Facet Joint Injections

Sacroiliac Joint Injection:

American Society of Interventional Pain Physicians Grading System

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology