Better than what? Comparisons in low back pain clinical trials
One article on PainSci cites Travers 2018: Studying the Studies
PainSci commentary on Travers 2018: ?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.
Many non-drug treatments are tricky to test scientifically, because it’s hard to compare them to a true fake treatment (like a comparing a drug to a sugar pill). Many scientists resort to comparing a treatment to some other treatment that we hope is “neutral” (probably doesn’t have much biological effect, like a sugar pill).
It’s a trap! Comparing a test treatment to an “active control” is likely to be misleading, because the active control pollutes the experiment with all kinds of unknown variables.
The point of this BJSM editorial is that these kinds of studies “need to be interpreted with caution.”
It doesn’t mean that they are all wrong, but it’s a significant and basic limitation that has to be taken seriously. And “these kinds of studies” constitute a large percentage of studies in musculoskeletal medicine.
Some excerpts that stood out:
- “For non-pharmacological treatments it is often difficult to introduce a credible sham and accounting solely for natural history is difficult in any circumstances”
- “Outperforming an active control does not necessarily indicate efficacy as it is possible for an unhelpful intervention to appear effective if the control intervention is harmful. An obvious example of this is when corticosteroid injections (known for their long-term deleterious effect) are used as a comparator in tendinopathy trials.”
- “The outcomes and recommendations drawn from clinical trials that utilise an active intervention as a control need to be interpreted with caution.”
~ Paul Ingraham
Specifically regarding Travers 2018:
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:
- 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.
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.