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The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain

Author/s: 
Sayed, D., Grider, J., Strand, N., Hagedorn, J. M., Falowski, S., Lam, C. M., Francio, V. T., Beall, D. P., Tomycz, N. D., Davanzo, J. R., Aiyer, R., Lee, D. W., Kaila, H., Sheen, S., Malinowski, M. N., Verdolin, M., Vodapally, S., Carayannopoulos, A., Jain, S., Azeem, N., Tolba, R., Chien, G. C. C., Ghosh, P., Mazzola, A. J., Amirdelfan, K., Chakravarthy, K., Petersen, E., Schatman, M. E., Deer, T.

Introduction
Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety.

Objective
The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders.

Methods
The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented.

Results
After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain.

Conclusion
The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.

Keywords: back pain, intervention, clinical guideline, spinal cord stimulation, minimally invasive spine procedure, lumbar disorder, epidural steroid injection, radiofrequency ablation

Keywords 
evidence-based interventional treatments Low Back Pain lumbar spinal disorders Pain

Angiotensin-converting-enzyme inhibitor–induced angioedema

Author/s: 
Quickfall, D., Jakubovic, B., Zipursky, J. S.

Angiotensin-converting-enzyme (ACE) inhibitors are the leading cause of drug-induced angioedema Angiotensin-converting-enzyme (ACE) inhibitors are responsible for 20%–40% of emergency department visits for angioedema.1 The incidence of ACE inhibitor–induced angioedema is about 0.1%–0.7% in the first 5 years of treatment; symptoms occur within the first month in 10% of cases.1 Risk factors include concomitant use of dipeptidyl peptidase-4 inhibitors (e.g., sitagliptin), mammalian target of rapamycin (mTOR) inhibitors (e.g., sirolimus) and neprilysin inhibitors (e.g., sacubitril) (Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/ cmaj.202308/tab-related-content).1 Nonsteroidal anti-inflammatory drugs and statins can exacerbate angioedema, and the risk of ACE inhibitor–induced angioedema is fivefold higher in Black people.2

Keywords 
inhibitor-induced angioedema swelling airway compromise angiotensin
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