Response to: Invasive Treatments for Low Back Disorders and the ACOEM Practice Guidelines
J Occup Environ Med
01 February 2022
There is a discrepancy in the guideline's recommendations regarding indications for epidural steroid injections (ESIs). Evidence supports the effectiveness of ESIs for the treatment of radicular pain—regardless of the underlying diagnosis. There appears to be a significant misunderstanding of the evidence regarding the diagnostic utility of medial branch blocks and the value of medial branch thermal radiofrequency neurotomy. Specifically, the single block false-positive rate is between 25% and 45%, and this is significantly reduced by the performance of a second comparative block. There is extensive high-quality evidence regarding the use of medial branch blocks and radiofrequency neurotomy for the evaluation and treatment of lumbar spine pain arising from the facet joints. Implantable spinal cord stimulation (SCS) is a well-established treatment for patients with refractory chronic pain.