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

PainSci » bibliography » Wang et al 2025
updated
Tags: treatment, injections, denervation, neck, back pain, bad news, scientific medicine, controversy, medicine, neurology, head/neck, spine, pain problems, debunkery

Six pages on PainSci cite Wang 2025: 1. The Complete Guide to Low Back Pain 2. The Complete Guide to Neck Pain & Cricks 3. Are Orthotics Worth It? 4. Microbreaking 5. Do Nerve Blocks Work for Neck Pain and Low Back Pain? 6. Block and burn for backs and necks bombs a big test, doctors bluster 

PainSci commentary on Wang 2025: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This review of the common "block and burn" treatments for neck and back pain was resoundingly bad news. All of the treatments studied were either radiofrequency ablation of nerves (“kill it with fire”) or some combination of injections of steroids or anaesthetics into muscles, joints, or epidural space. The abstract is a bit of a tangled mess of similar results for similar treatments, so I’ve tidied it up a bit for readability, and sorted roughly in order of descending certainty:

“Probably provide little to no difference in pain relief”:

“Little to no difference in pain relief (moderate certainty evidence)”:

“May provide little to no difference in pain relief (low certainty evidence)”:

“May increase pain (low certainty evidence)”:

“Very low certainty” evidence one way or the other:

It’s amazing that ablation hasn’t been studied well enough to get a clearer result. This is one of those moments when I wonder if evidence-based medicine is ever going to get its shit together.

So that’s a mixture of decent evidence-of-absence and murky but suspicious absence-of-evidence. As always, when a lot of weak and likely biased evidence fails to produce a clear positive signal, it’s extremely unlikely that strong and unbiased research will be an improvement.

~ Paul Ingraham

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To address the comparative effectiveness of common interventional procedures for chronic non-cancer (axial or radicular) spine pain.

DESIGN: Systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs).

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

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.

DATA EXTRACTION AND SYNTHESIS: Pairs of reviewers independently identified eligible studies, extracted data, and assessed risk of bias. We conducted frequentist network meta-analyses to summarise the evidence and used the GRADE approach to rate the certainty of evidence.

RESULTS: Of 132 eligible studies, 81 trials with 7977 patients that explored 13 interventional procedures or combinations of procedures were included in meta-analyses. All subsequent effects refer to comparisons with sham procedures. 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)). 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). 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). 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).

CONCLUSION: 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.

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