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Anaesthesia
Protocol
Interventional treatments for chronic, axial or radicular, non-cancer, spinal pain: a protocol for a systematic review and network meta-analysis of randomised trials
  1. Xiaoqin Wang1,
  2. Grace Martin2,
  3. Behnam Sadeghirad1,3,4,
  4. Andrea J Darzi3,5,
  5. Rachel J Couban1,
  6. Ivan D Florez6,
  7. Holly N Crandon7,
  8. Elena Kum3,
  9. Yaping Chang3,
  10. Meisam Abdar Esfahani3,
  11. Laxsanaa Sivananthan8,
  12. Fatemeh Mehrabi9,
  13. Neil K Sengupta2,
  14. Preksha Rathod2,
  15. Rami Z Morsi10,
  16. D Norman Buckley1,2,4,5,
  17. Gordon H Guyatt3,
  18. Y Raja Rampersaud11,12,
  19. Christopher J Standaert13,
  20. Thomas Agoritsas14,
  21. Jason W Busse1,3,4,5
  1. 1Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
  2. 2Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
  3. 3Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  4. 4Department of Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
  5. 5Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada
  6. 6Department of Pediatrics, Universidad de Antioquia, Medellin, Colombia
  7. 7Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
  8. 8Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  9. 9Pharmaceutic Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
  10. 10Department of Neurology, University of Chicago, Chicago, Illinois, USA
  11. 11Arthritis Program, Krembil Research Institute, Division of Orthopaedics, University Health Network, Toronto, Ontario, Canada
  12. 12Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  13. 13Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  14. 14Division General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
  1. Correspondence to Professor Jason W Busse; bussejw{at}mcmaster.ca

Abstract

Introduction Chronic, non-cancer, axial or radicular spinal pain is a common condition associated with considerable socioeconomic burden. Clinicians frequently offer patients various interventional procedures for the treatment of chronic spine pain; however, the comparative effectiveness and safety of available procedures remains uncertain.

Methods We will conduct a systematic review of randomised controlled trials that explores the effectiveness and harms of interventional procedures for the management of axial or radicular, chronic, non-cancer, spine pain. We will identify eligible studies through a systematic search of Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and Web of Science from inception without language restrictions. Eligible trials will: (1) enrol primarily adult patients (≥18 years old) with axial or radicular, chronic, non-cancer, spine pain, (2) randomise patients to different, currently available, interventional procedures or to an interventional procedure and a placebo/sham procedure or usual care, and (3) measure outcomes at least 1 month after randomisation.

Pairs of reviewers will independently screen articles identified through searches and extract information and assess risk of bias of eligible trials. We will use a modified Cochrane instrument to evaluate risk of bias. We will use frequentist random-effects network meta-analyses to assess the relative effects of interventional procedures, and five a priori hypotheses to explore between studies subgroup effects. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in evidence for each outcome, including direct, indirect and network estimates.

Ethics and dissemination No research ethics approval is required for this systematic review, as no confidential patient data will be used. We will disseminate our findings through publication in a peer-reviewed journal and conference presentations, and our review will support development of a BMJ Rapid Recommendations providing contextualised clinical guidance based on this body of evidence.

PROSPERO registration number CRD42020170667.

  • pain management
  • rehabilitation medicine
  • back pain
  • spine
  • interventional radiology
  • pain management
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-046025

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    Footnotes

    • Twitter @ivand_florez, @laxsanaa, @JasonWBusse

    • Contributors XW, GM, BS, AJD, RJC, IDF, HNC, EK, YC, MAE, LS, FM, NKS, PR, RZM, DNB, GHG, YRR, CJS, TA and JWB made substantial contributions to conception and design of the protocol. XW, GM and BS drafted the manuscript and JWB, YRR, RJC, AJD, CJS and TA revised it critically for important intellectual content. XW, GM, BS, AJD, RJC, IDF, HNC, EK, YC, MAE, LS, FM, NKS, PR, RZM, DNB, GHG, YRR, CJS, TA and JWB provided final approval of the version to be published. JWB is the guarantor of the review protocol.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests DNB and CJS declare intellectual and financial conflicts of interest, as pain physicians that perform interventional procedures for chronic spinal complaints as part of their practices. BS and TA are member of the GRADE Working Group.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.