PEER systematic review of randomized controlled trials
| Autor: | Danielle Perry, Liesbeth Froentjes, Scott Garrison, Karenn Chan, Anthony Train, Jamison Falk, Adrienne J. Lindblad, Jessica Kirkwood, James McCormack, Michael R. Kolber, Nicolas Dugré, Rodger Craig, G. Michael Allan, Joey Ton, Logan Sept, Michael Wollin, Samantha Moe, Christina Korownyk, Betsy Thomas |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Neuralgia Postherpetic Placebo law.invention 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Randomized controlled trial law Internal medicine Acupuncture Humans Duloxetine Medicine 030212 general & internal medicine Adverse effect Randomized Controlled Trials as Topic Analgesics Primary Health Care business.industry Research General Medicine Number needed to harm chemistry Neuropathic pain Number needed to treat Neuralgia Chronic Pain Family Practice business 030217 neurology & neurosurgery |
| Zdroj: | Can Fam Physician |
| ISSN: | 1715-5258 0008-350X |
| DOI: | 10.46747/cfp.6705e130 |
| Popis: | Objective To determine the proportion of chronic low back pain patients who achieve a clinically meaningful response from different pharmacologic and nonpharmacologic treatments. Data sources MEDLINE, EMBASE, Cochrane Library, and gray literature search. Study selection Published randomized controlled trials (RCTs) that reported a responder analysis of adults with chronic low back pain treated with any of the following 15 interventions: oral or topical nonsteroidal anti-inflammatory drugs (NSAIDs), exercise, acupuncture, spinal manipulation therapy, corticosteroid injections, acetaminophen, oral opioids, anticonvulsants, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors, cannabinoids, oral muscle relaxants, or topical rubefacients. Synthesis A total of 63 RCTs were included. There was moderate certainty that exercise (risk ratio [RR] of 1.71; 95% CI 1.37 to 2.15; number needed to treat [NNT] of 7), oral NSAIDs (RR = 1.44; 95% CI 1.17 to 1.78; NNT = 6), and SNRIs (duloxetine; RR = 1.25; 95% CI 1.13 to 1.38; NNT = 10) provide clinically meaningful benefits to patients with chronic low back pain. Exercise was the only intervention with sustained benefit (up to 48 weeks). There was low certainty that spinal manipulation therapy and topical rubefacients benefit patients. The benefit of acupuncture disappeared in higher-quality, longer (> 4 weeks) trials. Very low-quality evidence demonstrated that corticosteroid injections are ineffective. Patients treated with opioids had a greater likelihood of discontinuing treatment owing to an adverse event (number needed to harm of 5) than continuing treatment to derive any clinically meaningful benefit (NNT = 16), while those treated with SNRIs (duloxetine) had a similar likelihood of continuing treatment to attain benefit (NNT = 10) as those discontinuing the medication owing to an adverse event (number need to harm of 11). One trial each of anticonvulsants and topical NSAIDs found similar benefit to that of placebo. No RCTs of acetaminophen, cannabinoids, muscle relaxants, selective serotonin reuptake inhibitors, or tricyclic antidepressants met the inclusion criteria. Conclusion Exercise, oral NSAIDs, and SNRIs (duloxetine) provide a clinically meaningful reduction in pain, with exercise being the only intervention that demonstrated sustained benefit after the intervention ended. Future high-quality trials that report responder analyses are required to provide a better understanding of the benefits and harms of interventions for patients with chronic low back pain. |
| Databáze: | OpenAIRE |
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