03/21/2025
March 21, 2025
Dear Colleagues,
The North American Spine Society (NASS) along with 33 other societies representing physicians who treat chronic pain, developed a letter in response to a recent clinical practice guideline and systematic review/network meta-analysis published in The BMJ.
The response highlights the following:
• Heterogeneity: The systematic review/NMA and clinical guideline inappropriately aggregate diverse patient populations, diagnoses, spinal regions, and procedures.
• Omission and inaccuracy of extraction: Important studies were not included, and inaccurate data extraction from included studies casts doubt on reported results and conclusions.
• Technical fidelity: The publications fail to consider the importance of technical accuracy and procedural/technical factors that yield different results.
• Compassion and multi-modal care: These procedures are potential elective components of a multimodal treatment strategy and remain an essential treatment option for appropriate patients.
• Clinical guideline retraction request: Given the methodological issues and concerns regarding policy implications, The BMJ is encouraged to retract the guideline publication.
Although, intervention spine procedures are not the only options for patients with chronic pain, it is proven these procedures offer substantial relief in pain, improve function, allow patients to return to work, and possibly delay or obviate the need for more invasive surgical interventions or long-term dependency on opioids for these patients.
As a leader in the spine care community, NASS is committed to preserving patient access to safe and effective spinal procedures with appropriate clinical indications and will continue to advocate for these treatments and procedures on behalf of you and the millions of patients that you all serve!
Sincerely,
D. Scott Kreiner, MD
President, North American Spine Society
