Australian and New Zealand Association of Neurologists
Recommendations from the Australian and New Zealand Association of Neurologists on faints, headache disorders, low back pain, migraine & narrowed carotid arteries. ANZAN aims to ensure that high standards of clinical neurology are practised in Australia and New Zealand by playing an active role in training, continuing education and encouragement of teaching and research.
Don’t perform epidural steroid injections to treat patients with low back pain who do not have radicular symptoms in the legs originating from the nerve roots.
Lumbar epidural steroid injections may provide limited short term benefit (less than 3-6 months) for patients with an acute lumbar radiculopathy causing back pain and symptoms in the legs (Level C evidence). When there is low back pain alone, the outcomes of epidural steroid injections are poor. Although serious adverse events are rare, catastrophic events can occur and any symptom relief from the injection is typically brief. The inconsequential benefits of epidural steroid injections for low back pain without radicular symptoms do not outweigh its risks, no matter how small they may be.
- Choi HJ, Hahn S, Kim CH, et al. Epidural steroid injection therapy for low back pain: a meta-analysis. Int J Technol Assess Health Care 2013;29(3):244-53.
- Quaraishi NA. Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis. Eur Spine J 2012;21(2):214-9.
- Staal JB, de Bie R, de Vet HCW, et al. Injection therapy for subacute and chronic low-back pain. Cochrane Database Syst Rev 2008;16:(3).
The ANZAN Council considered 12 clinical practices in neurology which may be overused, inappropriate or of limited effectiveness in a given clinical context. After choosing the top 5 items to prioritise, these were passed on to the appropriate subspecialty committees within ANZAN for comment and additional suggestions. The final list of the top 5 items chosen was compiled following a review of the evidence and the formulation of suitable recommendations and endorsed by the Council on 7th January 2016.
- 1 Don’t perform imaging of the carotid arteries for simple faints.
- 2 Don’t perform imaging of the brain for non-acute primary headache disorders.
- 3 Don’t perform epidural steroid injections to treat patients with low back pain who do not have radicular symptoms in the legs originating from the nerve roots.
- 4 Don’t use opioids for the treatment of migraine, except in rare circumstances.
- 5 Don’t routinely recommend surgery for a narrowed carotid artery (>50% stenosis) that has not caused symptoms.