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Title: Lumbar facet joint injections for the management of chronic low back pain
Author: Snidvongs, Saowarat
ISNI:       0000 0004 7653 3540
Awarding Body: University of Exeter
Current Institution: University of Exeter
Date of Award: 2018
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Background: Low back pain is a leading cause of disability worldwide and has a significant economic burden. Targeted lumbar facet joint injections may be used to relieve this pain and aid rehabilitation, but high quality clinical evidence to support their use is lacking. The National Institute for Health and Care Excellence (NICE) does not recommend spinal injections for the management of chronic low back pain. Critical appraisal of systematic reviews: A critical appraisal of systematic reviews of randomised controlled trials concluded that the existing evidence to support the use of facet joint injections in low back pain management is equivocal, with methodological variability detected across the studies and reviews. FACET feasibility study: The FACET feasibility study was a blinded parallel two-arm pilot randomised controlled trial to assess the feasibility of carrying out a definitive study evaluating the effectiveness of lumbar facet joint injections compared with a sham procedure, in patients with non-specific low back pain of more than three months’ duration. The study recruited from the pain and spinal orthopaedic clinics at Barts Health NHS Trust only, although a multicentre study was planned. Adult patients referred to the specialist clinics with non-specific low back pain despite NICE-recommended best non-invasive care were randomised and blinded to receive either intra-articular lumbar facet joint injections with steroid or a sham procedure, following a positive response to diagnostic medial branch nerve blocks. Both groups were invited to attend a combined physical and psychological programme. Measures of feasibility included the recruitment and retention rate, and adherence to the study protocol. Questionnaires were used to assess a range of pain- and disability-related issues. Of 628 participants screened for eligibility, nine were randomised to receive the study intervention and eight participants completed the study. Failure to recruit sufficient participants led to early closure of the study by the funder, and no conclusions were drawn on the clinical effectiveness of lumbar facet joint injections for the management of non-specific low back pain in this sub-group of patients. Although the target recruitment rate was not achieved, a robust study protocol was developed and the intended interventions delivered safely, thus addressing many of the feasibility objectives. Conclusions: Further high quality randomised controlled trials and systematic reviews are required to inform decision makers, with implications for both clinical practice and policy. Stronger collaborations with primary care may improve the recruitment of patients earlier in their pain trajectory, suitable for inclusion in a future trial.
Supervisor: Taylor, Rod Sponsor: National Institute for Health Research
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available