AAPM Presidents Response to BMJ

AAPM Presidents Respond to the BMJ publication: “Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomized trials.

As current, past, and future Presidents of the American Academy of Pain Medicine, as well as practicing pain management physicians dedicated to improving our patients’ day to day lives, we have significant methodological concerns about the erroneous conclusions raised in the recent BMJ publication entitled: “Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomized trials.” This study evaluated all interventional spine procedures and arrived at an overbroad conclusion that interventional spine procedures are ineffective and should not be available to patients.

And we want to hear from you!

Like many of our members and fellow pain specialists, we experience the value of these often life-changing interventions for our patients, ranging from short-term to long-term pain relief. Some of the concerns, among many others, that we have with this review are:

1. Robust, contemporary, and relevant studies were excluded in the analysis.
   
2. Differing and evolving interventional techniques were inaccurately grouped together.
   
3. The authors claim that treatment should only be offered in randomized controlled trials (RCTs)–which would result in many patients with a treatable pain condition being undertreated or not treated at all.
4. Relevant and effective spine interventional procedures were excluded from this overarching analysis and there are statistical errors in data analysis.

AAPM is taking steps to advocate for our patients and pain medicine field in collaboration with other pain organizations to respond to these flawed conclusions on interventional spine procedures that many of our patients benefit from — and prevent unintended consequences for our patients.

What this article does tell us is that we require more and well-designed clinical trials. The high impact and cost of chronic pain for individuals and society justifies the need for increased funding for robust pain research. Interventional procedures are a critical part of patient-centric care, and with innovation and sound research, interventional procedures will continue to evolve to further improve lives and decrease disability.

AAPM stresses the value of team-based care, from interventions, medications, physical therapy, cognitive and mind-body techniques, to alternative therapies and more. Pain medicine is not a one-size-fits-all approach, constrained to flawed and overly broad reviews as well as insufficient, and under-funded science.

We support all our AAPM members, advocates, researchers, and patients as we lead continued discussions on best next steps for continuing to improve the lives of our patients with chronic pain.

At our annual meeting in Austin, Texas from April 3-6 we will have provocative conversations with all of you about the challenges of this BMJ review, next steps, and advocacy for our patients. Thank you for all you do.

We need your perspective, and we look forward to seeing you in Austin!