Two articles on PainSci cite Cambron 2017: 1. The Complete Guide to Low Back Pain 2. Are Orthotics Worth It?
PainSci commentary on Cambron 2017: ?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 wherever possible.
This trial tested the efficacy of shoe orthotics and chiropractic treatment for chronic low back pain. 225 patients were divided into three groups: a wait-list control group got no care at all, another group received custom, and a third group got custom orthotics plus chiropractic and massage treatment. The authors reported positive results up: “Six weeks of prescription shoe orthotics significantly improved back pain and dysfunction compared to no treatment.” But no differences after 12 weeks! And that’s even with an unfair advantage …
Wait-list groups are a crappy control. They suffer from “frustrebo” — poor outcomes caused by disappointment of knowing that you are not getting any treatment (see Power). This is a major flaw. As Dr. Stephen Ward tweeted, “Waiting list control, schwaiting list control.”
The lack of a true placebo control is a deal-breaker here, especially put in the context of other studies of orthotics for back pain, which are negative (e.g. see Chuter). Without replication, I think this study’s results can be dismissed as an outlier attributable to a flawed design and a high risk of bias.
~ 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.
OBJECTIVES: To investigate the efficacy of shoe orthotics with and without chiropractic treatment for chronic low back pain as compared to no treatment.
DESIGN: Randomized Controlled Trial
SETTING: An integrative medicine teaching clinic at a Midwestern university.
PARTICIPANTS: Two hundred and twenty-five adult subjects with symptomatic low back pain of 3 months or longer were recruited from a volunteer sample.
INTERVENTIONS: Subjects were randomized into one of three treatment groups (Orthotics, Plus, and Wait-list Groups). The Orthotics Group received custom-made shoe orthotics The Plus Group received custom-made orthotics plus chiropractic manipulation, hot or cold packs, and manual soft tissue massage. The Wait-list Group received no care.
MAIN OUTCOME MEASURES: The primary outcome measures were change in perceived back pain (Numeric Pain Rating Scale) and functional health status (Oswestry) after 6 weeks of study participation. Outcomes were also assessed after 12 weeks and then after an additional 3, 6, and 12 months.
RESULTS: After six weeks, all three groups demonstrated significant within-group improvement in average back pain, but only the Orthotics and Plus Groups had significant within-group improvement in function. When compared to the Wait-list Group, the Orthotics Group demonstrated significantly greater improvements in pain (p<0.0001) and function (p=0.0068). The addition of chiropractic to orthotics treatment demonstrated significantly greater improvements in function (p=0.0278) when compared to orthotics alone, but no significant difference in pain (p=0.3431). Group differences at 12 weeks and later were not significant.
CONCLUSIONS: Six weeks of prescription shoe orthotics significantly improved back pain and dysfunction compared to no treatment. The addition of chiropractic care led to higher improvements in function.
- “The effectiveness of shoe insoles for the prevention and treatment of low back pain: a systematic review and meta-analysis of randomised controlled trials,” Chuter et al, BMC Musculoskeletal Disorders, 2014.
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:
- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.