Evidence map›Paper›PMID 37227685›Full record

ReviewPain and therapy2023

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

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

Open access · goldAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Pain and therapy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
3.3field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Review
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 7 institutions in 1 country.

Laxmaiah ManchikantiPain Management Centers of America, 67 Lakeview Drive, Paducah, KY, 42001, USA. drlm@thepainmd.com.ORCID http://orcid.org/0000-0002-4201-9063
Nebojsa Nick KnezevicAdvocate Illinois Masonic Medical Center and College of Medicine, University of Illinois, Chicago, IL, USA.
Emilija KnezevicCollege of Liberal Arts and Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
Rachana PasupuletiUniversity of Kentucky, Lexington, KY, USA.
Alan D KayeLSU Health Sciences Center, Shreveport, Ochsner Shreveport Hospital and Interventional Pain Clinic Feist-Wieller Cancer Center, Shreveport, LA, USA.
Mahendra R SanapatiPain Management Centers of America, 67 Lakeview Drive, Paducah, KY, 42001, USA.
Joshua A HirschMassachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Harvard University · USLouisiana State University Health Sciences Center Shreveport · USPain Management Center of Paducah · USPain Management Centers Of America · USUniversity of Illinois Chicago · USUniversity of Illinois Urbana-Champaign · USUniversity of Kentucky · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionChronic 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.

methodsA 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).

resultsThe 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.

conclusionThe 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.

Indexed as

Chronic low back painEpidural scarringLumbar disc herniationLumbar spinal stenosisPercutaneous adhesiolysisPost lumbar surgery syndromeRadicular painSpinal pain

Identifiers

PMID37227685
PMCPMC10209570
OpenAlexW4378172843

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.