Systematic Guideline Search and Appraisal, as Well as Extraction of Relevant Recommendations, for a DMP "Chronic Back Pain" [Internet]

Key statement Research question The aim of the present investigation is to identify current, topic-relevant, evidence-based guidelines, extract their recommendations and designate those recommendations that are relevant for the care of patients in a disease management programme (DMP) “chronic back pain”.

Conclusion On the basis of a “Grade of Recommendation” (GoR) or alternatively a “Level of Evidence” (LoE) of the extracted recommendations from current evidence-based guidelines, relevant and potentially relevant recommendations on all prespecified healthcare aspects were identified for a DMP “chronic back pain”, with the exception of the healthcare aspect “treatment goals”. These commonly referred to recommendations advising against the use of a measure (negative recommendation).

The guidelines provide recommendations on diagnostics (standardized recording of symptoms, recording of psychosocial risk factors, imaging procedures, blood tests, diagnostic nerve blocks) and on recurrence prophylaxis (physical activity, shoe insoles and orthoses [negative recommendation], lumbar support belts [negative recommendation]).

For non-drug measures, recommendations were identified on massages and manual therapy, exercise and physiotherapy, as well as aqua gymnastics and yoga. Furthermore, negative recommendations were found on bed rest, behavioural therapy, transcutaneous electrical nerve stimulation (TENS) and percutaneous electrical nerve stimulation (PENS), device- supported traction treatment, orthoses, short-wave diathermy, therapeutic ultrasound, as well as on interference, magnetic field, and laser therapy.

The recommendations on drug therapy referred to oral analgesics such as flupirtine (negative recommendation), nonsteroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, muscle relaxants, antidepressants and other psychotropic drugs (negative recommendation), the additional administration of proton pump inhibitors, as well as intravenous or intramuscular administration of pain medication (negative recommendation). For invasive therapy, recommendations were identified on joint injections (negative recommendation), proliferation therapy (negative recommendation), and counselling about surgical treatment options.

Recommendations were also identified on the healthcare aspects of patient training, rehabilitation measures, and cooperation of healthcare sectors.

Inconsistent recommendations were identified on discography, non-drug therapy with acupuncture, as well as drug therapy with paracetamol and phytotherapeutics; these were proposed for further evaluation of their DMP relevance.

In addition, specific recommendations were identified for different patient subgroups (patients with radiculopathy and/or disc-related back pain, spinal canal stenosis, post-nucleotomy syndrome, lumbar facet joint pain, sacroiliac joint pain).