Comparative Effectiveness of Treatments for Chronic Low Back Pain: A Multiple Treatment Comparison Analysis

Primary tabs

SCIENCE
Comparative Effectiveness of Treatments for Chronic Low Back Pain: A Multiple Treatment Comparison Analysis
Key Take-Away: 

Among current treatment modalities, total disc replacement (TDR ) was found to be more efficacious whereas physical therapy (PT) was found to be least productive for chronic low back pain.

This comparison analysis determined the current treatment options for chronic low back pain (LBP) as defined by randomized controlled trials (RCTs) and to compare the effectiveness of those treatments using a mixed-treatment comparison (MTC). 

ABSTRACT: 
Background: 

This comparison analysis determined the current treatment options for chronic low back pain (LBP) as defined by randomized controlled trials (RCTs) and to compare the effectiveness of those treatments using a mixed-treatment comparison (MTC).

It is important to provide an evidence-based assessment of the treatment options that exist for LBP.

Methods: 

A systematic search of RCTs was conducted in MEDLINE and the Cochrane Collaboration Library from 1990 to 2014.

From the selected studies, preoperative and postoperative ODI and VAS back pain scores, additional surgeries, and complications were extracted. Standard and network meta-analytic techniques were used.

Results: 

A total of twelve RCTs were included in the analysis: 5 total disk replacement (TDR) versus fusion; 1 TDR versus exercise and cognitive behavioral therapy (CBT); 5 fusion versus exercise and CBT; and one fusion versus physical therapy (PT). On the basis of MTC, with respect to ODI change scores, the pooled mean difference favoring fusion over exercise and CBT was 2.0 points (95% CI, -1.2 to 4.8).

The pooled mean difference favoring TDR over exercise and CBT was 6.4 points (95% CI, 3.2-9.3). The pooled mean difference favoring fusion over PT was 8.8 points (95% CI, 4.1-13.6). The pooled mean differences favoring TDR over fusion was 4.4 points (95% CI, 2.37-6.63). For PT versus structured exercise with CBT, the pooled mean difference favoring exercise with CBT over PT was 6.8 points (95% CI, 1.5-12.8). For TDR versus PT, the pooled mean difference favoring TDR over PT was 13.2 points (95% CI, 8.0-18.4). Additional surgery rates were similar between treatment options.

Conclusion: 

All 4 treatments provided some benefit to patients with chronic LBP. According to the MTC analysis, TDR may be the most effective treatment and PT the least effective treatment for chronic LBP.

This review is based on a limited number of RCT studies and does not support any one treatment modality for all patients. 

Source:

Clin Spine Surg. 2017 Jun;30(5):204-225

Link to the source:

https://www.ncbi.nlm.nih.gov/pubmed/27831982

The original title of the article:

Comparative Effectiveness of Treatments for Chronic Low Back Pain: A Multiple Treatment Comparison Analysis.

Authors

Rihn JA et al.

Log in or register to post comments