PainSci summary of Artus 2010?This page is one of thousands in the PainScience.com 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 at the bottom of the page, as often as possible. ★★★★☆4-star ratings are for bigger/better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
“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.
- “Back pain: It ain’t what you do it’s … .?,” Neil O’Connell, BodyInMind.org.
- “The clinical course of low back pain: a meta-analysis comparing outcomes in randomised clinical trials (RCTs) and observational studies,” Majid Artus, Danielle van der Windt, Kelvin P Jordan, and Peter R Croft, BMC Musculoskeletal Disorders, 2014.
- “Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials,” L A C Machado, S J Kamper, R D Herbert, C G Maher, and J H McAuley, Rheumatology (Oxford), 2009.
One article on PainScience.com cites Artus 2010 as a source:
- PS Save Yourself from Low Back Pain! — Low back pain myths debunked and all your treatment options reviewed
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:
- Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Munteanu 2015 Br J Sports Med.
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.