To assess the effectiveness of interventions for acute and subacute non-specific low back pain (NS-LBP) based on pain and disability outcomes. A systematic review of the literature with network meta-analysis. Medline, Embase and CENTRAL databases were searched from inception until 17 October 2020. Randomised clinical trials (RCTs) involving adults with NS-LBP who experienced pain for less than 6 weeks (acute) or between 6 and 12 weeks (subacute). Forty-six RCTs (n=8765) were included; risk of bias was low in 9 trials (19.6%), unclear in 20 (43.5%), and high in 17 (36.9%). At immediate-term follow-up, for pain decrease, the most efficacious treatments against an inert therapy were: exercise (standardised mean difference (SMD) −1.40; 95% confidence interval (CI) −2.41 to –0.40), heat wrap (SMD −1.38; 95% CI −2.60 to –0.17), opioids (SMD −0.86; 95% CI −1.62 to –0.10), manual therapy (SMD −0.72; 95% CI −1.40 to –0.04) and non-steroidal anti-inflammatory drugs (NSAIDs) (SMD −0.53; 95% CI −0.97 to –0.09). Similar findings were confirmed for disability reduction in non-pharmacological and pharmacological networks, including muscle relaxants (SMD -0.24; 95% CI -0.43 to -0.04). Mild or moderate adverse events were reported in the opioids (65.7%), NSAIDs (54.3%) and steroids (46.9%) trial arms. With uncertainty of evidence, NS-LBP should be managed with non-pharmacological treatments which seem to mitigate pain and disability at immediate-term. Among pharmacological interventions, NSAIDs and muscle relaxants appear to offer the best harm–benefit balance.

Gianola S., Bargeri S., Del Castillo G., Corbetta D., Turolla A., Andreano A., et al. (2022). Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: A systematic review with network meta-analysis. BRITISH JOURNAL OF SPORTS MEDICINE, 56(1), 41-50 [10.1136/bjsports-2020-103596].

Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: A systematic review with network meta-analysis

Turolla A.;
2022

Abstract

To assess the effectiveness of interventions for acute and subacute non-specific low back pain (NS-LBP) based on pain and disability outcomes. A systematic review of the literature with network meta-analysis. Medline, Embase and CENTRAL databases were searched from inception until 17 October 2020. Randomised clinical trials (RCTs) involving adults with NS-LBP who experienced pain for less than 6 weeks (acute) or between 6 and 12 weeks (subacute). Forty-six RCTs (n=8765) were included; risk of bias was low in 9 trials (19.6%), unclear in 20 (43.5%), and high in 17 (36.9%). At immediate-term follow-up, for pain decrease, the most efficacious treatments against an inert therapy were: exercise (standardised mean difference (SMD) −1.40; 95% confidence interval (CI) −2.41 to –0.40), heat wrap (SMD −1.38; 95% CI −2.60 to –0.17), opioids (SMD −0.86; 95% CI −1.62 to –0.10), manual therapy (SMD −0.72; 95% CI −1.40 to –0.04) and non-steroidal anti-inflammatory drugs (NSAIDs) (SMD −0.53; 95% CI −0.97 to –0.09). Similar findings were confirmed for disability reduction in non-pharmacological and pharmacological networks, including muscle relaxants (SMD -0.24; 95% CI -0.43 to -0.04). Mild or moderate adverse events were reported in the opioids (65.7%), NSAIDs (54.3%) and steroids (46.9%) trial arms. With uncertainty of evidence, NS-LBP should be managed with non-pharmacological treatments which seem to mitigate pain and disability at immediate-term. Among pharmacological interventions, NSAIDs and muscle relaxants appear to offer the best harm–benefit balance.
2022
Gianola S., Bargeri S., Del Castillo G., Corbetta D., Turolla A., Andreano A., et al. (2022). Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: A systematic review with network meta-analysis. BRITISH JOURNAL OF SPORTS MEDICINE, 56(1), 41-50 [10.1136/bjsports-2020-103596].
Gianola S.; Bargeri S.; Del Castillo G.; Corbetta D.; Turolla A.; Andreano A.; Moja L.; Castellini G.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/854273
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