Low back pain symptoms show a similar pattern of improvement following a wide range of primary care treatments: a systematic review of randomized clinical trials

updated Mar 24, 2019

Tags: treatment, back pain, scientific medicine, pain problems, spine

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“Symptoms seem to improve in a similar pattern in clinical trials following a wide variety of active as well as inactive treatments.” That is, back pain patients improve with or without treatment. See Back pain for detailed analysis by Dr. Neil O’Connell. Note that a follow-up study in 2014 established that participating in an RCT isn’t the “active ingredient” in the observed improvements — on average, everyone improves about the same speed/amount, regardless of whether they are being studied or not (see Artus).

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.

OBJECTIVES: To assess overall responses to treatments among non-specific low back pain (NSLBP) patients in clinical trials to examine the pattern following a wide range of treatments.

METHODS: We conducted a systematic review of published trials on NSLBP and meta-analysis of within-group responses to treatments calculated as the standardized mean difference (SMD). We included randomized controlled trials that investigated the effectiveness of primary care treatments in NSLBP patients aged≥18 years. Outcome measures included the visual analogue scale for pain severity, Roland Morris Disability Questionnaire and Oswestry Disability Index for physical functioning.

RESULTS: One hundred and eighteen trials investigating a wide range of primary care treatment for NSLBP were included. Plots of response to treatments showed that there was a similar pattern of initial improvement at 6 weeks followed by smaller improvement for both pain and functional disability at long-term follow-up. This was also shown by the pooled SMD for pain which was 0.86 (95% CI 0.65, 1.07) at 6 weeks, 1.07 (95% CI 0.87, 1.27) at 13 weeks, 1.03 (95% CI 0.82, 1.25) at 27 weeks and 0.88 (95% CI 0.60, 1.1) at 52 weeks. There was a wide heterogeneity in the size of improvement. This heterogeneity, however, was not explained by differences in the type of treatment classified as active, placebo, usual care or waiting list controls or as pharmacological or non-pharmacological treatment.

CONCLUSIONS: NSLBP symptoms seem to improve in a similar pattern in clinical trials following a wide variety of active as well as inactive treatments. It is important to explore factors other than the treatment, that might influence symptom improvement.

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.

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