Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomised trials.

Methods

Systematic reviewand network meta-analysis(NMA) of randomised controlled trials (RCTs).

对随机对照试验（RCTs）进行系统评价和网络荟萃分析（NMA）。

data_sources

Medline, Embase, CINAHL, CENTRAL, and Web of Science from inception to 24 January 2023.

检索Medline、Embase、CINAHL、CENTRAL和Web of Science数据库，从建库至2023年1月24日的资料。

study_selection

RCTs that enrolled patients with chronic non-cancer spine pain, randomised to receive a commonly used interventional procedure versus sham procedure, usual care, or another interventional procedure.

纳入慢性非癌症脊柱疼痛患者参与的随机对照试验(RCTs)，随机接受常用干预程序与安慰剂程序、常规护理或另一种干预程序的比较。

data_extraction_and_synthesis

Pairs of reviewers independently identified eligible studies, extracted data, and assessed risk of bias.

成对的评审员独立识别符合条件的研究，提取数据，并评估偏倚风险。

We conducted frequentist network meta-analyses to summarise the evidence and used the GRADE approach to rate the certainty of evidence.

我们进行了频率网络荟萃分析以总结证据，并使用GRADE方法来评定证据的确定性。

Results

Of 132 eligible studies, 81 trials with 7977 patients that explored 13 interventional procedures or combinations of procedures were included in meta-analyses.

在132项符合条件的研究中，共有81项试验涉及7977名患者，这些试验探讨了13种干预措施或干预措施组合，并被纳入了荟萃分析。

All subsequent effects refer to comparisons with sham procedures.

所有后续效果均指与安慰剂程序的比较。

For chronic axial spine pain, the following probably provide little to no difference in pain relief (moderate certainty evidence): epidural injection of local anaesthetic (weighted mean difference (WMD) 0.28 cm on a 10 cm visual analogue scale (95% CI -1.18 to 1.75)), epidural injection of local anaesthetic and steroids (WMD 0.20 (-1.11 to 1.51)), and joint-targeted steroid injection (WMD 0.83 (-0.26 to 1.93)).

对于慢性轴性脊柱痛，以下治疗可能在缓解疼痛方面几乎没有差异（中等质量的证据）：硬膜外注射局部麻醉剂（加权平均差异（WMD）为10厘米视觉模拟量表上的0.28厘米（95%置信区间-1.18至1.75）），硬膜外注射局部麻醉剂和类固醇（WMD为0.20（-1.11至1.51）），以及针对关节的类固醇注射（WMD为0.83（-0.26至1.93））。

Intramuscular injection of local anaesthetic (WMD -0.53 (-1.97 to 0.92)), epidural steroid injection (WMD 0.39 (-0.94 to 1.71)), joint-targeted injection of local anaesthetic (WMD 0.63 (-0.57 to 1.83)), and joint-targeted injection of local anaesthetic with steroids (WMD 0.22 (-0.42 to 0.87)) may provide little to no difference in pain relief (low certainty evidence); intramuscular injection of local anaesthetic with steroids may increase pain (WMD 1.82 (-0.29 to 3.93)) (low certainty evidence).

肌肉注射局部麻醉剂（WMD为-0.53（-1.97至0.92）），硬膜外注射类固醇（WMD为0.39（-0.94至1.71）），针对关节的局部麻醉剂注射（WMD为0.63（-0.57至1.83）），以及针对关节的局部麻醉剂和类固醇注射（WMD为0.22（-0.42至0.87））可能在缓解疼痛方面几乎没有差异（低质量的证据）；肌肉注射局部麻醉剂和类固醇可能会增加疼痛（WMD为1.82（-0.29至3.93））（低质量的证据）。

Evidence for joint radiofrequency ablation proved of very low certainty.For chronic radicular spine pain, epidural injection of local anaesthetic and steroids (WMD -0.49 (-1.54 to 0.55)) and radiofrequency of dorsal root ganglion (WMD 0.15 (-0.98 to 1.28)) probably provide little to no difference in pain relief (moderate certainty evidence).

对于联合射频消融的证据证明其确定性非常低。对于慢性根性脊柱疼痛，硬膜外注射局部麻醉剂和类固醇（加权均数差（WMD）-0.49（-1.54至0.55））以及背根神经节的射频（WMD 0.15（-0.98至1.28））可能在缓解疼痛方面几乎没有差异（中等确定性证据）。

Epidural injection of local anaesthetic (WMD -0.26 (-1.37 to 0.84)) and epidural injection of steroids (WMD -0.56 (-1.30 to 0.17)) may result in little to no difference in pain relief (low certainty evidence).

硬膜外注射局部麻醉剂（加权均数差（WMD）-0.26（-1.37至0.84））和硬膜外注射类固醇（WMD -0.56（-1.30至0.17））可能导致在缓解疼痛方面几乎没有差异（低确定性证据）。

Conclusions

Our NMA of randomised trials provides low to moderate certainty evidence that, compared with sham procedures, commonly performed interventional procedures for axial or radicular chronic non-cancer spine pain may provide little to no pain relief.

我们的随机试验网络荟萃分析提供了低至中等质量的证据，表明与安慰剂程序相比，针对轴性或根性慢性非癌症脊柱疼痛的常见干预性程序可能几乎无法提供疼痛缓解。

registration

PROSPERO (CRD42020170667).

PROSPERO (CRD42020170667).