The American College of Radiology (ACR), American Society of Neuroradiology, Society of Interventional Radiology, and 31 other societies are demanding that the British Medical Journal (BMJ) retract guidelines that recommend against all injections and most radiofrequency neurotomy procedures for chronic back and neck pain.
“Our societies are concerned about the methodology and conclusions drawn in these publications and their potential impact on patient care,” stated the ACR in a March 20 bulletin. The challenges stem from a systematic review and network meta-analysis, subsequent clinical practice guidelines, and accompanying editorial published February 19 in the BMJ.
The practice guideline was based on an analysis of 132 eligible studies and 81 trials that explored 13 interventional procedures or combinations of procedures, according to the research. The authors concluded that commonly performed interventional procedures for axial or radicular chronic noncancer spine pain may provide little to no pain relief.
“Their works have stimulated important dialogue about the role of interventional procedures in managing chronic spine pain and have called appropriate attention to the need for high-quality randomized controlled trials (RCTs) to allow progressive improvement in clinical care for patients with spine pain,” stated the joint response of the ACR and societies, adding that the guideline conclusions aggregate disparate groups of patients, conditions, spinal regions, and procedures.
“Conflating these groups in analysis is convenient but misguided; in guideline development, it is misleading and irresponsible,” the response explained. “Another fatal flaw of the proposed guidelines is that they use studies of abandoned procedures and non-standard and non-covered techniques to draw conclusions about the use and coverage of commonly used and well-accepted techniques.
“We urge the BMJ to retract the flawed guideline publication …. We frankly cannot understand why this would be acceptable in any field of medicine, and we reject the authors’ position that the guidelines reflect a reasonable interpretation of the meta-analysis.”
Find the detailed seven-page response, including recommendations and policy implications, through the ACR website.