The Wrong Way to Treat Chronic Spine Pain

04/23/25 • 7 min

The BMJ, formerly the British Medical Journal, has issued a strong recommendation against several commonly used interventional procedures for non-cancer chronic spine pain. This "Rapid Recommendation" advises against joint radiofrequency ablation, epidural injections, joint-targeted injections, and intramuscular injections for chronic axial spine pain, as well as dorsal root ganglion radiofrequency and epidural injections for chronic radicular spine pain. The recommendation, based on a clinical practice guideline developed by an international expert panel, suggests that "all or nearly all well-informed people would likely not want such interventions" and that they should primarily be offered within clinical trials. This expert panel, comprised of patients, clinicians, and methodologists, based their guideline on systematic reviews and meta-analyses of existing research. An accompanying article in the BMJ highlights the significant cost burden of these often ineffective treatments, citing an estimated $9 billion spent annually on epidural injections in the U.S.. While these injections might offer relief for acute and subacute pain, they are often problematic for chronic pain. This new guideline signals a potential shift in how chronic spine pain is managed, emphasizing the need to reconsider the widespread use of these interventional procedures.

Previous Episode

Transforming Chiropractic Care in Latin America: A Global Call for Support

Chiropractic care in Latin America has experienced remarkable growth over the past 25 years, expanding from virtually no established schools or practitioners to 10 legitimate schools and significant numbers of chiropractors in countries like Brazil and Mexico. This growth signals increasing demand and trust in the profession. However, this rapid expansion has brought challenges, notably a lack of standardized regulation and accreditation which has allowed unqualified individuals and institutions to operate, potentially harming patients and the profession's reputation. Adding to the concern, physical therapy schools in Brazil have begun offering chiropractic as a supplementary procedure, setting a troubling precedent.

To address these critical issues, the Latin American Federation of Chiropractic (FLAQ) has spearheaded the development of the Council on Chiropractic Education - Latin America (CCE-LA). This council aims to establish educational standards across the region, ensuring graduates meet international levels of excellence. Achieving this requires financial support, and the international chiropractic community is being called upon to contribute to the urgent need for $40,000 to launch CCE-LA's accreditation process. Two anonymous donors are matching contributions up to $10,000, doubling the impact of donations. Supporting this initiative is crucial for safeguarding the future of chiropractic education, improving patient care, and protecting the profession's integrity in Latin America and globally.

Next Episode

Smarter Than Static Stretching: Prolonged Isometric Contractions

Forget everything you thought you knew about stretching injured or aging tendons! This article reveals that for conditions like Achilles tendinopathy, the real issue isn't tightness, but often an overly flexible or "compliant" tendon due to microscopic tears or age. This forces the calf muscles to operate in a shortened, weaker position. Aggressively stretching such a tendon would only worsen this problem.

Instead, research strongly supports using heavy-resistance, prolonged isometric contractions as a powerful way to actually tighten injured and aging tendons. This method can significantly increase tendon stiffness, allowing muscles to work more effectively and improve force output. Studies show remarkable results like increased Achilles tendon stiffness, improved running economy, and immediate, significant pain reduction in painful tendinopathy. These safe and effective exercises empower patients, decrease reliance on pain medication, and underscore that "Exercise is medicine".