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Can we identify types of back pain patients that respond better to treatments?

PainSci » bibliography » Saragiotto et al 2017
Tags: research, back pain, pro, pain problems, spine

Six articles on PainSci cite Saragiotto 2017: 1. The Complete Guide to Low Back Pain2. The Complete Guide to Chronic Tension Headaches3. The Complete Guide to Neck Pain & Cricks4. The Chiropractic Controversies5. Does Spinal Manipulation Work?6. Cognitive Behavioural Therapy for Chronic Pain

PainSci commentary on Saragiotto 2017: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

These authors conclude that the idea that some back pain patients respond better to some treatments is probably still mostly hype.

Most low back pain has no known cause and is therefore considered “non-specific,” and there’s a wide range of response to treatment in these patients. A common assumption is that they actually have specific causes for their pain, even though we can’t identify them — but there is a hope that we can identify the patients who respond to specific treatments. This is the hope or hype about “subgrouping”: you don’t necessary have to understand how their pain works to identify types of patients that will respond better to treatment. There is a large, enthusiastic movement in back pain research to achieve this.

In this paper, in which the authors thoroughly “have deliberately chosen to argue 2 extreme positions,” both for and against the investigation of subgroups. Key points in favour:

And key points against:

They conclude: “the current research initiatives and achievements in this field are far from optimal and not yet ready to be implemented in clinical practice.”

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Clinicians and clinical researchers share a common goal of achieving better outcomes for patients with low back pain (LBP). For that, randomized controlled trials and systematic reviews are the most reliable study designs to determine the effects of interventions. Subgroup analyses in these research designs have been used to examine treatment-effect modification across subgroups defined by patient characteristics. In this Viewpoint, the authors present supporting and opposing arguments for the subgrouping approach in nonspecific LBP, considering the progress made so far in the LBP field and the relevant literature in adjacent fields. J Orthop Sports Phys Ther 2017;47(2):44-48. doi:10.2519/jospt.2017.0602.

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This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights: