NEWS 3
ausdoc. com. au 16 MAY 2025
NEWS 3
‘ Irresponsible and misleading’
NEWSPIX
Medical groups demand BMJ retract guideline on chronic spine pain.
Mohana Basu THIRTY-FOUR pain medicine societies are calling on The BMJ to retract a clinical practice guideline that advises against interventional procedures for chronic spine pain.
The guideline, part of the BMJ Rapid Recommendations series, recommends that procedures such as epidural injections of anaesthetics or steroids should not be offered to adults with chronic axial or radicular spine pain that is not associated with cancer or inflammatory arthropathy, outside of clinical trials.
It was based on a network meta-analysis, published in the same journal, which evaluated 81 trials covering nearly 8000 patients.
“ Our network meta-analysis of randomised trials provides low to moderate certainty evidence that, compared with sham procedures, commonly performed interventional procedures for axial or radicular chronic non-cancer spine pain may provide little to no pain relief,” the authors concluded.
The linked guideline suggested that most well-informed patients would decline such interventions, given the current evidence.
However, pain specialists and interventional spine clinicians issued a co-ordinated response, arguing that the underlying analysis suffered from“ broad treatment heterogeneity”— where studies involving different procedures, patient populations
It suffered from‘ broad treatment heterogeneity’.
and anatomical regions were pooled together in a way they described as clinically meaningless.
“ A serious clinician would not use evidence about non-ablative sacroiliac joint pulsed radiofrequency to inform treatment in the cervical spine,” they said in their statement, subsequently published in The Spine Journal and Interventional Pain Medicine.
The 34 groups— including the World Institute of Pain, and the World Academy of Pain Medicine United— further alleged that the review excluded key studies.
“ For example, the systematic review / network meta-analysis omitted the strongest randomised controlled trial addressing the efficacy and effectiveness of lumbar transforaminal epidural steroid injections.”
They also highlighted a lack of attention to procedural technical standards, such as needle placement, lesion parameters and anatomical targeting.
They warned that if doctors denied these procedures based on inaccurate analysis, it would lead to more invasive, expensive and riskier treatments.
They demanded The BMJ retract the clinical practice guideline, calling it“ misleading” and“ irresponsible”.
The corresponding author for the guideline, Professor Jason Busse from McMaster University in Canada, said the methodology was peer-reviewed and had been used previously for reviews and associated guidelines.
“ The main concern raised by various interventional pain societies seems to be that none of the 132 trials of interventional procedures for chronic spine pain should be statistically pooled, and only narrative synthesis is appropriate,” he told Australian Doctor.
“ We did pool outcomes across trials of the same types of procedures, stratified by the presentation of complaint( axial or radicular pain), and then explored for heterogeneity.
“ Our protocol was peer-reviewed and published, and pre-registered on PROSPERO.
“ If some clinicians believe that they can correctly identify patients with chronic spine pain who will benefit from interventional procedures, we believe they should undertake high-quality, sham-controlled trials to provide evidence,” he said.
“ As we note in our guideline, such evidence would alter our recommendations.”
Leading Australian pain specialist Associate Professor Michael Vagg said he supported
Associate Professor Michael Vagg. the calls to retract the guideline.
The BMJ publication had“ some real strengths” he said, but the review and the guideline had two big issues: lack of specialist involvement and failure to reflect the complexity of chronic pain treatment.
“[ The guideline writers ] made some decisions that they wouldn’ t have done if they had had input from people who actually know the literature well.” BMJ 2025; 19 Feb. Spine J 2025; 2 Apr.
Fed Govt offers $ 3.8m to save bulk-billing clinic
Finance Minister Katy Gallagher.
Rachel Carter THE high-profile Canberra practice placed in voluntary administration last month will reopen, at least in the short term, under a deal with an unnamed private operator.
The Interchange Health Co-operative, which universally bulk-billed its 4900 patients, has also secured a pledge of a further $ 3.8 million from the Federal Government to keep it afloat long-term.
Offering drug and alcohol services as well as gender-affirming care, the practice had relied on Medicare rebates, a handful of government grants and, controversially for a bulk-billing practice, annual membership fees of $ 60 or $ 120.
But it recently called in administrators saying that with a vulnerable patient cohort, the clinic’ s business model could no longer“ meet current market rates and conditions to attract much-needed doctors into our practice”.
The Federal Government said it will also invest a further $ 3.8 million through the ACT Primary Health Network, helping the clinic attract and retain GPs and perform renovations and capital works on the building. However, the money is contingent on bulk-billing all patients and staying fully operational for three years, said federal ACT Senator Katy Gallagher.
Washing work clothes at home an‘ infection risk’
Carmel Sparke DOCTORS and nurses who wash their work clothes in their home washing machines may be contributing to hospital-acquired infections and the rise of microbial-resistant bacteria, UK researchers say.
Their test of six domestic washing machines found that half of the models did not disinfect fabric samples contaminated with Enterococcus faecium bacteria during a 60 ° C rapid cycle.
And a third failed during a standard 60 ° C cycle, wrote the team, from De Montfort University in Leicester, UK.
“ Healthcare workers’ uniforms can serve as fomites for pathogenic micro-organisms, transferring them from hospital environments to domestic laundering machines,” they said.
“ If these micro-organisms are not effectively eradicated during laundering, they can contaminate the domestic laundering machine, spread to other garments and potentially return to healthcare settings, exposing patients to harmful pathogens and increasing the risk of infection.”
Decontamination was considered to be achieved with a ≥5 log 10 colony-forming unit reduction, according to the study, which was partly funded by the UK’ s peak body for industrial laundry and textile rental.
Pathogenic bacteria had previously been shown to spread through garments in healthcare settings, the authors said.
In 2012, an anaesthetic nurse’ s scrubs were identified as being responsible for spreading Gordonia bronchialis to three patients.
The strain was found on the nurse’ s body and scrubs, and the outbreak stopped after the disposal of the washing machine.
And in 2019, a beta-lactamase-producing Klebsiella oxytoca strain spread through a paediatric ward, with 13 newborns and one child testing positive.
Most of the machines assessed failed to maintain their peak temperature of 60 ° C for the recommended 10 minutes.
The researchers recommended not using rapid cycles, using washing machine disinfectants, running a 90 ° C cycle to clean the machine, separating hospital clothes from the rest of the wash, and prioritising industrial laundering of uniforms.
PLOS ONE 2025; 30 Apr.