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Open Access 25-05-2023 | Opioids | REVIEW

Efficacy of Percutaneous Adhesiolysis in Managing Low Back and Lower Extremity Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Authors: Laxmaiah Manchikanti, Nebojsa Nick Knezevic, Emilija Knezevic, Rachana Pasupuleti, Alan D. Kaye, Mahendra R. Sanapati, Joshua A. Hirsch

Published in: Pain and Therapy | Issue 4/2023

Abstract

Introduction

Chronic refractory low back and lower extremity pain recalcitrant to conservative management and epidural injections secondary to postsurgery syndrome, spinal stenosis, and disc herniation are sometimes managed with percutaneous adhesiolysis. Consequently, this systematic review and meta-analysis was undertaken to assess the efficacy of percutaneous adhesiolysis in managing low back and lower extremity pain.

Methods

A systematic review and meta-analysis of randomized controlled trials (RCTs) utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was performed. A comprehensive literature search of multiple databases from 1966 to July 2022, including manual searches of the bibliography of known review articles was performed. Quality assessment of the included trials, meta-analysis, and best evidence synthesis was performed.

The primary outcome measure was a significant reduction in pain (short term up to 6 months and long term more than 6 months).

Results

The search identified 26 publications, with 9 trials meeting the inclusion criteria. The results of dual-arm and single-arm analyses showed significant improvement in pain and function at 12 months. Opioid consumption was also significantly reduced at 6 months with dual-arm analysis, whereas single-arm analysis showed a significant decrease from baseline to treatment at the 3-, 6-, and 12-month analyses. At 1 year follow-up, seven of seven trials were positive for improvements in pain relief, function, and diminution of opioid use.

Discussion

Based on the present systematic review of nine RCTs, the evidence level is I to II, with moderate to strong recommendation for percutaneous adhesiolysis in managing low back and lower extremity pain. The limitations of the evidence include paucity of literature, lack of placebo-controlled trials, and the majority of the trials studying post lumbar surgery syndrome.

Conclusion

The evidence is level I to II or strong to moderate based on five high-quality and two moderate-quality RCTs, with 1 year follow-up that percutaneous adhesiolysis is efficacious in the treatment of chronic refractory low back and lower extremity pain.

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Title: Efficacy of Percutaneous Adhesiolysis in Managing Low Back and Lower Extremity Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Laxmaiah Manchikanti
Nebojsa Nick Knezevic
Emilija Knezevic
Rachana Pasupuleti
Alan D. Kaye
Mahendra R. Sanapati
Joshua A. Hirsch
Publication date: 25-05-2023
Publisher: Springer Healthcare
Keywords: Opioids
Opioids
Back Pain
Back Pain
Spinal Stenosis
Disc Herniation
Lumbar Disc Herniation
Lumbar Disc Herniation
Back Pain
Published in: Pain and Therapy / Issue 4/2023
Print ISSN: 2193-8237
Electronic ISSN: 2193-651X
DOI: https://doi.org/10.1007/s40122-023-00508-y

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A Response to: Letter to the Editor Regarding “Role of Serratus Anterior Plane Block in Breast Surgeries”

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