Guidelines for composing and assessing a paper on the treatment of pain: A practical application of evidence-based medicine principles to a cost-effectiveness analysis of the MINT randomized clinical trials

Affiliations

¹ Division of Physical Medicine & Rehabilitation, Department of Orthopaedics & Rehabilitation, University of New Mexico School of Medicine, Albuquerque, NM, USA.
² Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA.
³ Department of Epidemiology and Global Health, Umeå University, Sweden, and Smartkliniken Eques Indolor, Vallentuna, Sweden.
⁴ Department of Neurosurgery, Centro Hospitalar e Universitário de Coimbra (CHUC), Porto, Portugal.
⁵ Department of Physical Medicine & Rehabilitation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁶ Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA.
⁷ Michael J. McKenna, MDPC, Las Vegas, NV, USA.
⁸ Department of Rehabilitation Medicine and Multidisciplinary Pain Program at Montefiore Medical Center, Bronx, NY, USA.
⁹ Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA.
¹⁰ Spine Intervention Society, Hinsdale, IL, USA.
¹¹ Department of Neurological Surgery, University of Southern California, Los Angeles, CA, USA.

PMID: 39238811
PMCID: PMC11372985
DOI: 10.1016/j.inpm.2022.100010

Editorial

Guidelines for composing and assessing a paper on the treatment of pain: A practical application of evidence-based medicine principles to a cost-effectiveness analysis of the MINT randomized clinical trials

Reza Ehsanian et al. Interv Pain Med. 2022.

. 2022 Jan 28;1(1):100010.

doi: 10.1016/j.inpm.2022.100010. eCollection 2022 Mar.

Authors

Affiliations

¹ Division of Physical Medicine & Rehabilitation, Department of Orthopaedics & Rehabilitation, University of New Mexico School of Medicine, Albuquerque, NM, USA.
² Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA.
³ Department of Epidemiology and Global Health, Umeå University, Sweden, and Smartkliniken Eques Indolor, Vallentuna, Sweden.
⁴ Department of Neurosurgery, Centro Hospitalar e Universitário de Coimbra (CHUC), Porto, Portugal.
⁵ Department of Physical Medicine & Rehabilitation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁶ Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA.
⁷ Michael J. McKenna, MDPC, Las Vegas, NV, USA.
⁸ Department of Rehabilitation Medicine and Multidisciplinary Pain Program at Montefiore Medical Center, Bronx, NY, USA.
⁹ Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA.
¹⁰ Spine Intervention Society, Hinsdale, IL, USA.
¹¹ Department of Neurological Surgery, University of Southern California, Los Angeles, CA, USA.

PMID: 39238811
PMCID: PMC11372985
DOI: 10.1016/j.inpm.2022.100010

Abstract

Objective: Apply established principles of evidence-based medicine to the interpretation of the cost-effectiveness analysis related to the MINT Randomized Clinical Trials (RCTs).

Design: Editorial.

Methods: Spine Intervention Society's guidelines for assessing studies on the treatment of pain were applied to a published cost-effectiveness analysis of radiofrequency denervation data from the MINT RCTs.

Results: Application of evidence-based medicine principles reveals the MINT RCTs' major deficiencies in patient selection, diagnostic paradigm, radiofrequency neurotomy technique, co-interventions, outcome measurement, power analysis study sample characteristics, data analysis, and loss to follow-up; which marginalizes the generalizability and conclusions of the cost-effectiveness analysis.

Conclusions: The cost analysis performed in "Cost-Effectiveness of Radiofrequency Denervation for Patients With Chronic Low Back Pain: The MINT Randomized Clinical Trials" is based on the MINT RCTs results. The MINT RCTs significant metholodological design flaws, lead to issues in validty for the subsequent cost-effectiveness analysis. Application of the cost-effective analysis to patient care paradigms should be limited given the concerns with validity.

Keywords: Chronic Low Back Pain; Cost Effectiveness; Evidence-Based Medicine; Facet Joint; Radiofrequency Neurotomy; Sacroiliac Joint; Zygapophysial Joint.

PubMed Disclaimer

Cited by

International Society for the Advancement of Spine Surgery Statement: Restorative Neurostimulation for Chronic Mechanical Low Back Pain Resulting From Neuromuscular Instability.
Lorio M, Lewandrowski KU, Coric D, Phillips F, Shaffrey CI. Lorio M, et al. Int J Spine Surg. 2023 Oct;17(5):728-750. doi: 10.14444/8525. Epub 2023 Aug 10. Int J Spine Surg. 2023. PMID: 37562978 Free PMC article.

References

1. Bogduk N., Kennedy D.J., Vorobeychik Y., Engel A. Guidelines for composing and assessing a paper on treatment of pain. Pain Med Malden Mass. 2017;18:2096–2104. doi: 10.1093/pm/pnx121. - DOI - PubMed
1. Evidence-Based Medicine - Spine Intervention Society n.d. https://www.spineintervention.org/general/custom.asp?page=S5_EBM (accessed May 24, 2021).
1. McCormick Z.L., Vorobeychik Y., Gill J.S., Kao M.-C.J., Duszynski B., Smuck M., et al. Guidelines for composing and assessing a paper on the treatment of pain: a practical application of evidence-based medicine principles to the Mint randomized clinical trials. Pain Med Malden Mass. 2018;19:2127–2137. doi: 10.1093/pm/pny046. - DOI - PubMed
1. Maas E.T., Juch J.N.S., Ostelo R.W.J.G., Groeneweg J.G., Kallewaard J.-W., Koes B.W., et al. Costeffectiveness of radiofrequency denervation for patients with chronic low back pain: the MINT randomized clinical trials. Value Health J Int Soc Pharmacoecon Outcomes Res. 2020;23:585–594. doi: 10.1016/j.jval.2019.12.009. - DOI - PubMed
1. Hambraeus J., Ehsanian R., Cheng D.S., McKenna M.J., McCormick Z.L. Inadequate selection and treatment results in poor outcomes and lack of cost-effectiveness. Value Health J Int Soc Pharmacoecon Outcomes Res. 2021;24:1234–1235. doi: 10.1016/j.jval.2020.11.024. - DOI - PubMed

Publication types

Actions

LinkOut - more resources

Full Text Sources
- Elsevier Science
- PubMed Central

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Guidelines for composing and assessing a paper on the treatment of pain: A practical application of evidence-based medicine principles to a cost-effectiveness analysis of the MINT randomized clinical trials

Affiliations

Guidelines for composing and assessing a paper on the treatment of pain: A practical application of evidence-based medicine principles to a cost-effectiveness analysis of the MINT randomized clinical trials

Authors

Affiliations

Abstract

Similar articles

Cited by

References

Publication types

LinkOut - more resources

Full Text Sources