The grades of recommendations (standards, guidelines, and options) and classes of evidence (I–III) are defined at the end of the "Major Recommendations" field.
Therapeutic Recommendations
Standards. Facet injections are not recommended as long-term treatment for chronic low-back pain.
Guidelines. There is insufficient evidence to recommend a treatment guideline.
Options. The use of lumbar epidural injections or trigger point injections (TPIs) is not recommended as a treatment option for long-term relief of chronic low-back pain. The use of lumbar epidural injections, facet injections, or TPIs is recommended as a treatment option to provide temporary, symptomatic relief in selected patients with chronic low-back pain.
Diagnostic Recommendations
Standards. There is insufficient evidence to recommend a diagnostic standard.
Guidelines. There is insufficient evidence to recommend a diagnostic guideline.
Options. The use of lumbar facet injections is recommended as a diagnostic tool for predicting the response to lumbar facet radiofrequency (RF) ablation. The use of lumbar facet injections is not recommended as a diagnostic tool to predict the response to lumbar fusion surgery.
Summary
In summary, there is no meaningful evidence in the medical literature that the use of epidural injections is of any long-term value in the treatment of patients with chronic low-back pain. The literature does indicate that the use of lumbar epidural injections can provide short-term relief in selected patients with chronic low-back pain.
There is evidence that suggests that facet joint injections can be used to predict outcome after radiofrequency ablation of a facet joint. The predictive ability of facet joint injections does not appear to apply to lumbar fusion surgery. No evidence exists to support the effectiveness of facet injections in the treatment of patients with chronic low-back pain.
There is conflicting evidence suggesting that the use of local TPIs can be effective for the short-term relief of low-back pain. There are no data to suggest that TPIs with either steroids or anesthetics alone provide lasting benefit for patients suffering from chronic low-back pain.
Definitions:
Grades of Recommendation
Standards Recommendations of the strongest type, based on Class I evidence reflecting a high degree of clinical certainty
Guidelines Recommendations based on Class II evidence reflecting a moderate degree of clinical certainty
Options Recommendations based on Class III evidence reflecting unclear clinical certainty
Classes of Evidence
Class I Evidence from one or more well-designed, randomized controlled clinical trials, including overviews of such trials
Class II Evidence from one or more well-designed comparative clinical studies, such as nonrandomized cohort studies, case-control studies, and other comparable studies, including less well-designed randomized controlled trials
Class III Evidence from case series, comparative studies with historical controls, case reports, and expert opinion as well as significantly flawed randomized controlled trials
