Journal CME October 2024, Medication recommendations for treatment of lumbosacral radiculopathy: A systematic review of clinical practice guidelines-PM R - 2024 - Price - Medication recommendations for treatment of lumbosacral radiculopathy A systematic review of

PM R - 2024 - Price - Medication recommendations for treatment of lumbosacral radiculopathy A systematic review of

Pdf Summary

The systematic review aimed to identify recommended medications for treating lumbosacral radicular symptoms (LSRS) from clinical practice guidelines (CPGs), evaluate these guidelines' quality, and summarize their recommendations. Researchers analyzed guidelines published between January 2017 and January 2022 across several databases. The AGREE II tool was used to assess the quality of the guidelines. <br /><br />The study included 11 CPGs from seven countries, all reflecting high quality with an average score of 87.1%. Clarity of presentation scored highest, while applicability scored lowest. The findings showed that the recommended medications varied significantly between guidelines with antidepressants, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids being the most commonly suggested. Antidepressants, especially TCAs and SNRIs, were the most frequently recommended class, despite evidence being considered inconclusive by some guidelines. NSAIDs were suggested by four CPGs, though others recommended against them or found the evidence inconclusive. Opioids were advocated by four guidelines for short-term use, particularly tramadol as a second-line treatment.<br /><br />Recommendations against specific drugs were more straightforward: no guidelines recommended using acetaminophen, muscle relaxants, benzodiazepines, or antibiotics for LSRS, underlining concerns about their efficacy and potential harms.<br /><br />The study highlighted a lack of consensus in pharmacological treatments for LSRS and suggests that non-pharmacological treatments be considered as core components of care plans. Future research should address the effectiveness and safety of these medications, particularly focusing on opioids, anticonvulsants, and corticosteroids. The review calls for improved guideline consistency to aid uniform treatment strategies across different specialties.

Keywords

lumbosacral radicular symptoms

clinical practice guidelines

medications

AGREE II tool

antidepressants

NSAIDs

opioids

pharmacological treatments

guideline consistency

non-pharmacological treatments