low back pain

Lumbar Belt for Nonspecific Low Back Pain: A Randomized Clinical Trial

Nathan Hinkle — Fri, 21 Aug 2026 05:00:00 +0000

Date Added:

August 21, 2026

Journal/Publication:

JAMA Network Open

Publisher:

The American Medical Association

Publication Date:

August 19, 2026

Issue:

Volume:

Pages:

1-13

URL:

Lumbar Belt for Nonspecific Low Back Pain: A Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

doi:10.1001/jamanetworkopen.2026.29793

Keywords

Nonspecific Low Back Pain

Randomized Clinical Trial

Adults

MeSH

low back pain

Adult

Surveys and Questionaires

RPR Commentary: Non-rigid lumbar support belts appear to reduce pain and disability in people with non-specific low back pain for at least 6 months. Not sure about the strength of the control. James W. Mold, MD, MPH

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Importance Nonspecific low back pain is highly prevalent and disabling. Most current guidelines state that evidence is insufficient to recommend lumbar belts for this condition.

Objective To determine whether a soft and extensible lumbar belt reduces functional disability and pain in patients with nonspecific low back pain.

Design, Setting, and Participants This multicenter, open-label, randomized clinical trial was conducted at 17 medical centers across France from February 26, 2021, to March 28, 2024. Participants were adults with nonspecific low back pain lasting 1 to 6 months. Data were analyzed from August 7, 2024, to June 18, 2025.

Interventions Patients were randomized using an interactive web response system to wear a nonrigid lumbar belt for 12 weeks in addition to usual care or to receive usual care without a device.

Main Outcomes and Measures The primary outcome was the between-group difference in mean change in the Oswestry Disability Index (ODI) score from baseline to week 12. Outcomes were assessed at baseline, week 4, and week 12; pain was also reported weekly using online questionnaires.

Results At total of 168 patients were randomized (mean [SD] age, 49.0 [13.7] years; 101 women [60.1%]), with 86 participants in the belt group and 82 participants in the usual care group. The primary analysis included 155 patients with at least 1 postrandomization assessment (81 patients in the belt group; 74 patients in the control group). ODI improvement from baseline to week 12 was greater in the belt group (change, −10.0 [95% CI, −13.0 to −7.0] points) than in the control group (change, −5.3 [95% CI, −8.6 to −2.1] points), with a between-group difference of −4.7 (95% CI, −8.4 to −0.9) points (P = .01). Reductions in pain at rest and during activity were also greater in the belt group, with between-group differences of −8.7 (95% CI, −16.1 to −1.3) points (P = .02) and −10.0 (95% CI, −18.3 to −1.6) points (P = .02), respectively. Over 12 weeks, medication use was lower in the belt group than in the control group (41 patients [50.6%] vs 50 patients [67.6%]; P = .03). No serious device-related adverse events occurred.

Conclusions and Relevance In this randomized clinical trial, adding a nonrigid lumbar belt to usual care resulted in improved pain and functional disability in patients with nonspecific low back pain lasting 1 to 6 months. These findings suggest that lumbar belts may be considered as a nonpharmacological option for symptom management.

Author/s:

Laurent Grange, Paul Calmels, Yves-Marie Pers, Guillaume Laustriat, Valerie Wieczorek, Nassima Saih, Mathieu De-Seze, Christelle Nguyen, Camille Daste, Isabelle Fayolle-Minon, Emmanuel Coudeyre, Francois Rannou

Low Back Pain A Review

Nathan Hinkle — Wed, 17 Jun 2026 01:37:34 +0000

Date Added:

June 16, 2026

Journal/Publication:

Journal of the American Medical Association

Publisher:

The American Medical Association

Publication Date:

June 15, 2026

Pages:

E1-E15

URL:

Low Back Pain: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

Low Back Pain

Nonspecific Low Back Pain

MeSH

low back pain

pain management

self-management

Disability-Adjusted Life Years

RPR Commentary: A review of what we think we know about low back pain. James W. Mold, MD, MPH

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Abstract
Importance Low back pain is defined as pain localized below the costal margin and above the inferior gluteal fold, with or without leg pain. Low back pain affects approximately 619 million people worldwide and is the leading cause of years lived with disability worldwide.

Observations Approximately 90% of patients presenting for care with low back pain have nonspecific low back pain, which is defined as low back pain that is not associated with specific spinal disorders (such as lumbar radiculopathy, lumbar spinal stenosis, vertebral fracture, axial spondyloarthritis, infection, or malignancy). Low back pain is classified as acute if the duration is shorter than 6 weeks, subacute if the duration is 6 to 12 weeks, and chronic when the duration is longer than 12 weeks. The age-standardized prevalence of low back pain is higher in females (9330 per 100 000) than in males (5520 per 100 000). The prevalence of low back pain increases with age, peaking at approximately 85 years. Risk factors for low back pain include obesity, depressive symptoms, occupational exposures (eg, heavy lifting), tobacco use, chronic disease (eg, diabetes), and previous low back pain. Acute nonspecific low back pain is usually self-limited, and approximately 72% of individuals recover by 12 months. Prognosis is less favorable for chronic nonspecific low back pain, but 42% of patients recover within 12 months. Initial management of patients with low back pain of any duration includes reassurance that serious underlying disease is unlikely, discussion about the expected time course of recovery, and the recommendation to remain physically active. Patients should be encouraged to continue their usual activities (including work), avoid prolonged rest, and be advised to self-manage their condition, which consists of symptom-relief strategies (such as heat application) and activity pacing (maintaining or gradually increasing usual activities and work). For patients with acute nonspecific low back pain, first-line therapies include heat application, spinal manipulation, massage, and acupuncture (typically provided by physical therapists, chiropractors, acupuncturists, and massage therapists) as well as nonsteroidal anti-inflammatory drugs (NSAIDs; such as ibuprofen) and skeletal muscle relaxants (such as cyclobenzaprine). For chronic nonspecific low back pain, first-line therapies include exercise of any type, psychological therapies (eg, cognitive behavioral therapy), or combined multidisciplinary approaches (such as pain management programs and integrated exercise and psychological care) along with spinal manipulation, massage, and acupuncture. NSAIDs should be considered as second-line therapy for chronic nonspecific low back pain.

Conclusions and Relevance Low back pain is a leading cause of disability worldwide. Acute nonspecific low back pain is often self-limited, whereas chronic nonspecific low back pain has a less favorable prognosis. For patients with acute nonspecific low back pain, first-line treatments include selected nonpharmacological therapies and medications (such as NSAIDs and skeletal muscle relaxants). For patients with chronic nonspecific low back pain, first-line treatment consists of exercise, psychological therapies (such as cognitive behavioral therapy), and combined multidisciplinary care.

Author/s:

Aidan G. Cashin, Roger Chou, Melissa B. Weimer

I Am Worried I Have Sciatica-What Do I Need to Know?

Erin Blanchette — Tue, 21 Nov 2023 20:35:07 +0000

Date Added:

November 21, 2023

Journal/Publication:

JAMA Internal Medicine

Publisher:

American Medical Association

Publication Date:

November 13, 2023

URL:

I Am Worried I Have Sciatica-What Do I Need to Know?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamainternmed.2023.5990

Keywords

PMID (1):

37955926

MeSH

Anti-Inflammatory Agents

Hypesthesia

Information for patients about sciatica. James W. Mold, MD, MPH

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This JAMA Internal Medicine Patient Page reviews sciatica, its symptoms, and treatment options for those who have it.

Sciatica is a type of pain that is caused by irritation of the sciatic nerve. This nerve travels from the low back down the legs. Sciatica most commonly happens when a disk in your spine gets damaged or worn out and presses on the sciatic nerve.

Author/s:

Grace Y Zhang, Michael A Incze

The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain

Aubrey Delammermore — Sat, 07 Jan 2023 06:00:00 +0000

Date Added:

January 7, 2023

Journal/Publication:

Journal of Pain Research

Publisher:

DovePress

Publication Date:

December 6, 2022

Issue:

Pages:

3729-3832

URL:

The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.2147/JPR.S386879

Keywords

evidence-based

interventional treatments

Low Back Pain

lumbar spinal disorders

Pain

PMID (1):

36510616

MeSH

Neurosurgery

anesthesiology

low back pain

Physical and Rehabilitation Medicine

Radiofrequency Ablation

A comprehensive evidence-based review of a variety of interventions for low back pain syndromes. James W. Mold, MD, MPH

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Introduction
Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety.

Objective
The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders.

Methods
The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented.

Results
After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain.

Conclusion
The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.

Keywords: back pain, intervention, clinical guideline, spinal cord stimulation, minimally invasive spine procedure, lumbar disorder, epidural steroid injection, radiofrequency ablation

Author/s:

Sayed, D., Grider, J., Strand, N., Hagedorn, J. M., Falowski, S., Lam, C. M., Francio, V. T., Beall, D. P., Tomycz, N. D., Davanzo, J. R., Aiyer, R., Lee, D. W., Kaila, H., Sheen, S., Malinowski, M. N., Verdolin, M., Vodapally, S., Carayannopoulos, A., Jain, S., Azeem, N., Tolba, R., Chien, G. C. C., Ghosh, P., Mazzola, A. J., Amirdelfan, K., Chakravarthy, K., Petersen, E., Schatman, M. E., Deer, T.

The Effectiveness of Intraosseous Basivertebral Nerve Radiofrequency Ablation for the Treatment of Vertebrogenic Low Back Pain: An Updated Systematic Review with Single-Arm Meta-analysis

Aubrey Delammermore — Wed, 27 Jul 2022 05:00:00 +0000

Date Added:

July 27, 2022

Journal/Publication:

Pain Medicine

Publisher:

Oxford University Press

Publication Date:

July 20, 2022

Issue:

Issue Supplement 2

Volume:

Pages:

S50-S62

URL:

The Effectiveness of Intraosseous Basivertebral Nerve Radiofrequency Ablation for the Treatment of Vertebrogenic Low Back Pain: An Updated Systematic Review with Single-Arm Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1093/pm/pnac070

Keywords

PMID (1):

35856331

MeSH

Confidence Intervals

low back pain

Visual Analog Scale

Radiofrequency Ablation

MEDLINE

Basi-vertebral nerve radiofrequency ablation is a new approach to management of chronic low back pain that appears to be fairly effective though more research is needed. James W. Mold, MD, MPH

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Objective. To provide an estimate of the effectiveness of basivertebral nerve (BVN) radiofrequency ablation (RFA) to
treat vertebrogenic low back pain (LBP). Design. Systematic review with single-arm meta-analysis. Population.
Persons 18 years of age with chronic LBP associated with type 1 or 2 Modic changes. Intervention. Intraosseous
BVN RFA. Comparison. Sham, placebo procedure, active standard care treatment, or none. Outcomes. The proportion
of patients treated with BVN RFA who reported 50% pain score improvement on a visual analog scale or numeric
rating scale. The main secondary outcome was 15-point improvement in Oswestry Disability Index score. Methods.
Three reviewers independently assessed articles published before December 6, 2021, in MEDLINE and Embase. The
Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to evaluate
the overall quality of evidence. Results. Of the 856 unique records screened, 12 publications met the inclusion criteria,
representing six unique study populations, with 414 participants allocated to receive BVN RFA. Single-arm metaanalysis showed a success rate of 65% (95% confidence interval [CI] 51–78%) and 64% (95% CI 43–82%) for 50%
pain relief at 6 and 12 months, respectively. Rates of 15-point Oswestry Disability Index score improvement were
75% (95% CI 63–86%) and 75% (95% CI 63–85%) at 6 and 12 months, respectively. Conclusion. According to GRADE,
there is moderate-quality evidence that BVN RFA effectively reduces pain and disability in most patients with vertebr

Author/s:

Conger, A., Burnham, T. R., Clark, T., Teramoto, M, McCormick, Z. L.

Nonspecific Low Back Pain

Saige Blanchard — Tue, 10 May 2022 05:00:00 +0000

Date Added:

May 10, 2022

Journal/Publication:

New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

May 5, 2022

Issue:

Volume:

386

Pages:

1732-1740

URL:

Nonspecific Low Back Pain

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMcp2032396

Keywords

back pain

Nonspecific Low Back Pain

MeSH

A review of what we think we know about non-specific low back pain. James W. Mold, MD, MPH

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Low back pain typically defined as pain below the costal margin and above the inferior gluteal folds with or without leg pain 1 is worldwide the most prevalent and most disabling of the conditions that are considered to benefit from rehabilitation 2 In a systematic review that included 165 studies from 54 countries the mean point prevalence of low back pain in the general adult population was approximately 12 with a higher prevalence among persons 40 years of age or older and among women the lifetime prevalence was approximately 40 3 Low back pain is classified as specific pain and other symptoms that are caused by specific pathophysiological mechanisms of nonspinal or spinal origin or nonspecific back pain with or without leg pain without a clear nociceptive-specific cause 4 Nonspinal causes of specific low back pain include hip conditions diseases of the pelvic organs e g prostatitis and endometriosis and vascular e g aortic aneurysm or systemic disorders spinal causes include herniated disk spinal stenosis fracture tumor infection and axial spondyloarthritis Lumbar disorders with radicular pain due to nerve-root involvement have a higher prevalence 5 to 10 than other spinal causes the two most frequent causes of such back pain are herniated disk and spinal stenosis 5 The overall prevalence of the other spinal disorders is low among patients with acute low back pain For example among 1172 patients who presented to primary care clinicians in Australia with acute low back pain only 11 0 9 were found to have serious spinal conditions mostly fractures during 1 year of follow-up 6 The authors of a Dutch study that involved primary care patients reported axial spondyloarthritis in almost one quarter of adults 20 to 45 years of age who presented with chronic low back pain 7 although these findings have not been replicated In contrast to low back pain caused by specific identifiable causes nonspecific low back pain probably develops from the interaction of biologic psychological and social factors 4 and it accounts for approximately 80 to 90 of all cases of low back pain 1 Low back pain is usually classified according to pain duration as acute 6 weeks subacute 6 to 12 weeks or chronic 12 weeks

Author/s:

Chiarotto, A., Koes, B. W.

Non-steroidal anti-inflammatory drugs for acute low back pain

Devin Evans — Fri, 23 Apr 2021 05:00:00 +0000

Date Added:

April 23, 2021

Journal/Publication:

Cochrane Database of Systematic Reviews

Publisher:

Cochrane Library

Publication Date:

April 16, 2021

Issue:

Volume:

URL:

Non-steroidal anti-inflammatory drugs for acute low back pain

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858.CD013581

Keywords

back pain

Pain

Tylenol

PMID (1):

32297973

MeSH

low back pain

Anti-Inflammatory Agents, Non-Steroidal

Sciatica

Apparently NSAIDS aren’t much more effective than placebo or Tylenol for acute low back pain, but don’t discount the effectiveness of a good, safe placebo. James W. Mold, MD, MPH

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Background: Acute low back pain (LBP) is a common health problem. Non-steroidal anti-inflammatory drugs (NSAIDs) are often used in the treatment of LBP, particularly in people with acute LBP. In 2008, a Cochrane Review was published about the efficacy of NSAIDs for LBP (acute, chronic, and sciatica), identifying a small but significant effect in favour of NSAIDs compared to placebo for short-term pain reduction and global improvement in participants with acute LBP. This is an update of the previous review, focusing on acute LBP.

Objectives: To assess the effects of NSAIDs compared to placebo and other comparison treatments for acute LBP.

Search methods: We searched CENTRAL, MEDLINE, Embase, PubMed, and two trials registers for randomised controlled trials (RCT) to 7 January 2020. We also screened the reference lists from relevant reviews and included studies.

Selection criteria: We included RCTs that assessed the use of one or more types of NSAIDs compared to placebo (the main comparison) or alternative treatments for acute LBP in adults (≥ 18 years); conducted in both primary and secondary care settings. We assessed the effects of treatment on pain reduction, disability, global improvement, adverse events, and return to work.

Data collection and analysis: Two review authors independently selected trials to be included in this review, evaluated the risk of bias, and extracted the data. If appropriate, we performed a meta-analysis, using a random-effects model throughout, due to expected variability between studies. We assessed the quality of the evidence using the GRADE approach. We used standard methodological procedures recommended by Cochrane.

Main results: We included 32 trials, with a total of 5356 participants (age range 16 to 78 years). Follow-up ranged from one day to six months. Studies were conducted across the globe, the majority taking place in Europe and North-America. Africa and the Eastern Mediterranean region were not represented. We considered seven studies at low risk of bias. Performance and attrition were the most common biases. There was often a lack of information on randomisation procedures and allocation concealment (selection bias); studies were prone to selective reporting bias, since most studies did not register their trials. Almost half of the studies were industry-funded. There is moderate quality evidence that NSAIDs are slightly more effective in short-term (≤ 3 weeks) reduction of pain intensity (visual analogue scale (VAS), 0 to 100) than placebo (mean difference (MD) -7.29 (95% confidence interval (CI) -10.98 to -3.61; 4 RCTs, N = 815). There is high quality evidence that NSAIDs are slightly more effective for short-term improvement in disability (Roland Morris Disability Questionnaire (RMDQ), 0 to 24) than placebo (MD -2.02, 95% CI -2.89 to -1.15; 2 RCTs, N = 471). The magnitude of these effects is small and probably not clinically relevant. There is low quality evidence that NSAIDs are slightly more effective for short-term global improvement than placebo (risk ratio (RR) 1.40, 95% CI 1.12 to 1.75; 5 RCTs, N = 1201), but there was substantial heterogeneity (I² 52%) between studies. There is very low quality evidence of no clear difference in the proportion of participants experiencing adverse events when using NSAIDs compared to placebo (RR 0.86, 95% CI 0.63 to 1.18; 6 RCTs, N = 1394). There is very low quality evidence of no clear difference between the proportion of participants who could return to work after seven days between those who used NSAIDs and those who used placebo (RR 1.48, 95% CI 0.98 to 2.23; 1 RCT, N = 266). There is low quality evidence of no clear difference in short-term reduction of pain intensity between those who took selective COX-2 inhibitor NSAIDs compared to non-selective NSAIDs (mean change from baseline -2.60, 95% CI -9.23 to 4.03; 2 RCTs, N = 437). There is moderate quality evidence of conflicting results for short-term disability improvement between groups (2 RCTs, N = 437). Low quality evidence from one trial (N = 333) reported no clear difference between groups in the proportion of participants experiencing global improvement. There is very low quality evidence of no clear difference in the proportion of participants experiencing adverse events between those who took COX-2 inhibitors and non-selective NSAIDs (RR 0.97, 95% CI 0.63 to 1.50; 2 RCTs, N = 444). No data were reported for return to work.

Authors' conclusions: This updated Cochrane Review included 32 trials to evaluate the efficacy of NSAIDs in people with acute LBP. The quality of the evidence ranged from high to very low, thus further research is (very) likely to have an important impact on our confidence in the estimates of effect, and may change the estimates. NSAIDs seemed slightly more effective than placebo for short-term pain reduction (moderate certainty), disability (high certainty), and global improvement (low certainty), but the magnitude of the effects is small and probably not clinically relevant. There was no clear difference in short-term pain reduction (low certainty) when comparing selective COX-2 inhibitors to non-selective NSAIDs. We found very low evidence of no clear difference in the proportion of participants experiencing adverse events in both the comparison of NSAIDs versus placebo and selective COX-2 inhibitors versus non-selective NSAIDs. We were unable to draw conclusions about adverse events and the safety of NSAIDs for longer-term use, since we only included RCTs with a primary focus on short-term use of NSAIDs and a short follow-up. These are not optimal for answering questions about longer-term or rare adverse events.

Author/s:

Van der Gaag, W.H., Roelofs, P.D., Enthoven, W.T., Van Tulder, M.W., Koes, B.W.

Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care

Devin Evans — Wed, 24 Feb 2021 06:00:00 +0000

Date Added:

February 24, 2021

Journal/Publication:

Journal of the American Medical Association Network Open

Publication Date:

February 1, 2021

Issue:

Volume:

URL:

Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2020.37371

Keywords

PMID (1):

33591367

MeSH

Patients with acute low back pain are more likely to progress to chronic low back pain if they are prescribed opioids or referred for imaging studies or subspecialists (after controlling for other risk factors). James W. Mold, MD, MPH

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Importance: Acute low back pain (LBP) is highly prevalent, with a presumed favorable prognosis; however, once chronic, LBP becomes a disabling and expensive condition. Acute to chronic LBP transition rates vary widely owing to absence of standardized operational definitions, and it is unknown whether a standardized prognostic tool (ie, Subgroups for Targeted Treatment Back tool [SBT]) can estimate this transition or whether early non-guideline concordant treatment is associated with the transition to chronic LBP.

Objective: To assess the associations between the transition from acute to chronic LBP with SBT risk strata; demographic, clinical, and practice characteristics; and guideline nonconcordant processes of care.

Design, setting, and participants: This inception cohort study was conducted alongside a multisite, pragmatic cluster randomized trial. Adult patients with acute LBP stratified by SBT risk were enrolled in 77 primary care practices in 4 regions across the United States between May 2016 and June 2018 and followed up for 6 months, with final follow-up completed by March 2019. Data analysis was conducted from January to March 2020.

Exposures: SBT risk strata and early LBP guideline nonconcordant processes of care (eg, receipt of opioids, imaging, and subspecialty referral).

Main outcomes and measures: Transition from acute to chronic LBP at 6 months using the National Institutes of Health Task Force on Research Standards consensus definition of chronic LBP. Patient demographic characteristics, clinical factors, and LBP process of care were obtained via electronic medical records.

Results: Overall, 5233 patients with acute LBP (3029 [58%] women; 4353 [83%] White individuals; mean [SD] age 50.6 [16.9] years; 1788 [34%] low risk; 2152 [41%] medium risk; and 1293 [25%] high risk) were included. Overall transition rate to chronic LBP at six months was 32% (1666 patients). In a multivariable model, SBT risk stratum was positively associated with transition to chronic LBP (eg, high-risk vs low-risk groups: adjusted odds ratio [aOR], 2.45; 95% CI, 2.00-2.98; P < .001). Patient and clinical characteristics associated with transition to chronic LBP included obesity (aOR, 1.52; 95% CI, 1.28-1.80; P < .001); smoking (aOR, 1.56; 95% CI, 1.29-1.89; P < .001); severe and very severe baseline disability (aOR, 1.82; 95% CI, 1.48-2.24; P < .001 and aOR, 2.08; 95% CI, 1.60-2.68; P < .001, respectively) and diagnosed depression/anxiety (aOR, 1.66; 95% CI, 1.28-2.15; P < .001). After controlling for all other variables, patients exposed to 1, 2, or 3 nonconcordant processes of care within the first 21 days were 1.39 (95% CI, 1.21-2.32), 1.88 (95% CI, 1.53-2.32), and 2.16 (95% CI, 1.10-4.25) times more likely to develop chronic LBP compared with those with no exposure (P < .001).

Conclusions and relevance: In this cohort study, the transition rate to chronic LBP was substantial

Author/s:

Stevans, Joel M., Delitto, Anthony, Khoja, Samannaaz, Patterson, Charity G., Smith, Clair N., Schneider, Michael J., Freburger, Janet K., Greco, Carol M., Freel, Jennifer A., Sowa, Gwendolyn A., Wasan, Ajay D., Brennan, Gerard P., Hunter, Stephen J., Minick, Kate I., Wegener, Stephen T., Ephraim, Patti L., Friedman, Michael", Jason M., Robert B.

Recognizing Axial Spondyloarthritis: A Guide for Primary Care

Devin Evans — Wed, 04 Nov 2020 06:00:00 +0000

Date Added:

November 4, 2020

Publisher:

Mayo Clinic Proceedings

Publication Date:

July 29, 2020

Issue:

Volume:

Pages:

2499-2508

URL:

Recognizing Axial Spondyloarthritis: A Guide for Primary Care

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2020.02.007

Keywords

back pain

Axial Spondyloarthritis

primary care

PMID (1):

32736944

MeSH

A systematic review of what we know currently about axial spondyloarthritis, formerly known as ankylosing spondylitis. James W. Mold, MD, MPH

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Axial spondyloarthritis (axSpA) is an important cause of chronic low back pain and affects approximately 1% of the US population. The back pain associated with axSpA has a characteristic pattern referred to as inflammatory back pain (IBP). Features of IBP include insidious onset before age 45 years, association with morning stiffness, improvement with exercise but not rest, alternating buttock pain, and good response to treatment with nonsteroidal anti-inflammatory drugs. In patients with IBP, it is essential to look for other features associated with spondyloarthritis (SpA), such as enthesitis, dactylitis, peripheral arthritis, extra-articular manifestations (eg, psoriasis, uveitis, or inflammatory bowel disease), human leukocyte antigen B27 positivity, and a family history of SpA. Axial SpA is underrecognized, and a delay of several years between symptom onset and diagnosis is common. However, with new and effective therapies available for the treatment of active axSpA, early recognition and diagnosis are of critical importance. For this narrative review, we conducted a literature search of English-language articles using PubMed. Individual searches were performed to identify potential articles of interest related to axSpA (search terms: ["axSpA" OR "axial SpA" OR "axial spondyloarthritis" OR "ankylosing spondylitis"]) in combination with terms related to IBP ("inflammatory back pain" OR "IBP" OR "chronic back pain" OR "CBP" OR "lower back pain" OR "LBP"), diagnosis (["diagn∗" OR "classification"] AND ["criteria" OR "recommend∗" OR "guidelines"]), and referral ("refer∗"). No date range was formally selected, as we were interested in providing an overview of the evolution of these concepts in clinical practice. We supplemented the review with insights based on our clinical expertise. Patients with chronic back pain should be screened for IBP and other SpA features; suspicion for axSpA should trigger referral to a rheumatologist for further evaluation.

Author/s:

Magrey, Marina N., Danve, Abhijeet S., Ermann, Joerg, Walsh, Jessica A.

Recognizing Axial Spondyloarthritis: A Guide for Primary Care

Brian Desmarais — Mon, 03 Aug 2020 15:25:32 +0000

Date Added:

August 3, 2020

Journal/Publication:

Mayo Clinic Proceedings

Publication Date:

July 29, 2020

URL:

Recognizing Axial Spondyloarthritis: A Guide for Primary Care

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.190777

MeSH

low back pain

Spondylitis, Ankylosing

Rheumatologists

language

O,O-diisopropyl-S-benzylthiophosphate

Buttocks

Spondylarthritis

Back Pain

Anti-Inflammatory Agents, Non-Steroidal

PubMed

Inflammatory Bowel Diseases

Uveitis

Psoriasis

Education, Medical

A nice review of the recognition, diagnosis, and management of patients with axial spondyloarthritis (ankylosing spondylitis). James W. Mold, MD, MPH

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Author/s:

Magrey, M.N., Danve, A.S., Ermann, J., Walsh, J.A.

Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Comparative Effectiveness Review No. 227

John Bayhi — Fri, 17 Apr 2020 18:16:34 +0000

Date Added:

April 17, 2020

Journal/Publication:

AHRQ Publication No. 20-EHC009

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

April 16, 2020

URL:

Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Comparative Effectiveness Review No. 227

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.23970/AHRQEPCCER227

Keywords

nonpharmacological treatment

MeSH

tension-type headache

Mindfulness

Low-Level Light Therapy

MEDLINE

follow-up studies

AHRQ evidence review of non-invasive, non-pharmacologic treatments for relief of chronic pain. James W. Mold, MD, MPH

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Objectives. We updated the evidence from our 2018 report assessing persistent improvement in outcomes following completion of therapy for noninvasive nonpharmacological treatment for selected chronic pain conditions.

Data sources. Electronic databases (Ovid MEDLINE®, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews) through November 2017 (for prior report) and from September 2017 through September 2019 (for this update report), reference lists, ClinicalTrials.gov, and our previous report.

Review methods. Using predefined criteria, we selected randomized controlled trials (RCTs) of noninvasive nonpharmacological treatments for five common chronic pain conditions (chronic low back pain; chronic neck pain; osteoarthritis of the knee, hip, or hand; fibromyalgia; and tension headache) that reported results for a at least 1 month postintervention. We analyzed effects and assessed strength of evidence (SOE) at short term (1 to <6 months following treatment completion), intermediate term (≥6 to <12 months), and long term (≥12 months).

Results. We included 233 RCTs (31 new to this update). Many were small (N<70), and evidence beyond 12 months after treatment completion was sparse. The most common comparison was with usual care. Evidence on harms was limited, with no evidence suggesting increased risk for serious treatment-related harms for any intervention. Effect sizes were generally small for function and pain.

Chronic low back pain: Psychological therapies were associated with small improvements compared with usual care or an attention control for both function and pain at short-term, intermediate-term, and long-term followup (SOE: moderate). Function improved over short and/or intermediate term for exercise, low-level laser therapy, spinal manipulation, massage, yoga, acupuncture, and multidisciplinary rehabilitation (SOE moderate at short term for exercise, massage, and yoga; low for all others). Improvements in pain at short term were seen for massage, mindfulness-based stress reduction, acupuncture, and multidisciplinary rehabilitation (SOE: moderate), and exercise, low-level laser therapy, and yoga (SOE: low). At intermediate term, spinal manipulation, yoga, multidisciplinary rehabilitation (SOE: moderate) and exercise and mindfulness-based stress reduction (SOE: low) were associated with improved pain. Compared with exercise, multidisciplinary rehabilitation improved both function and pain at short and intermediate terms (small effects, SOE: moderate.)

Chronic neck pain: In the short term, low-level laser therapy (SOE: moderate) and massage (SOE: low) improved function and pain. Exercise in general improved function long term, and combination exercise improved function and pain both short and long term compared with usual care (SOE: low). Acupuncture improved function short and intermediate term, but there was no pain improvement compared with sham acupuncture (SOE: low). Compared with acetaminophen, Pilates improved both function and pain (SOE: low).

Osteoarthritis pain: Exercise resulted in small improvements in function and pain at short-term (SOE: moderate) and long-term (SOE: low), and moderate improvement at intermediate-term (SOE: low) followup for knee osteoarthritis versus nonactive comparators. Small improvements in function and pain with exercise were seen for hip osteoarthritis short term (SOE: low). Functional improvement persisted into intermediate term, but pain improvement did not (SOE: low).

Fibromyalgia: Functional improvements were seen with exercise, mind-body practices, multidisciplinary rehabilitation (SOE: low) and acupuncture (SOE: moderate) short term compared with usual care, attention control, or sham treatment. At intermediate term, there was functional improvement with exercise and acupuncture (SOE: moderate), cognitive-behavioral therapy (CBT), mindfulness-based stress reduction, myofascial release, and multidisciplinary rehabilitation (SOE: low). Long term, functional improvements persisted for multidisciplinary rehabilitation without improvement in pain (SOE: low). Compared with exercise, tai chi conferred improvement in function short and intermediate term (SOE: low). Pain was improved with exercise (short and intermediate term, SOE moderate), and for CBT (short term), mindfulness practices, and multidisciplinary rehabilitation (intermediate term) (SOE low).

Chronic tension headache: Evidence was sparse and the majority of trials were of poor quality. Spinal manipulation resulted in moderate improvement in pain short term.

Conclusions. Trials identified subsequent to the earlier report largely support previous findings—namely that exercise, multidisciplinary rehabilitation, acupuncture, CBT, mindfulness practices, massage, and mind-body practices most consistently improve function and/or pain beyond the course of therapy for specific chronic pain conditions. Additional research, including comparisons with pharmacological and other active controls, on effects beyond the immediate post-treatment period is needed, particularly for conditions other than low back pain.

Author/s:

Skelly, AC, Chou, R, Dettori, JR, Turner, JA, Friedly, JL, Rundell, SD, Fu, Brodt, ED, Wasson, N, Kantner, S, Ferguson, AJR

Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review

Tracy Ashby — Mon, 20 Aug 2018 05:00:00 +0000

Date Added:

August 21, 2018

Journal/Publication:

Comparative Effectiveness Review

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

June 11, 2018

Issue:

209

URL:

Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.23970/AHRQEPCCER209

Keywords

chronic pain

nonpharmacological treatment

noninvasive treatment

MeSH

This systematic review found that several non-pharmacological therapies appear to improve both pain and function in patients with chronic pain. The abstract is on pages ix and x. Tables summarizing the strength of evidence for various approaches begin on G1.

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Objectives. Many interventions are available to manage chronic pain; understanding the durability of treatment effects may assist with treatment selection. We sought to assess which noninvasive nonpharmacological treatments for selected chronic pain conditions are associated with persistent improvement in function and pain outcomes at least 1 month after the completion of treatment.

Data sources. Electronic databases (Ovid MEDLINE®, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews) through November 2017, reference lists, and ClinicalTrials.gov.

Review methods. Using predefined criteria, we selected randomized controlled trials of noninvasive nonpharmacological treatments for five common chronic pain conditions (chronic low back pain; chronic neck pain; osteoarthritis of the knee, hip, or hand; fibromyalgia; and tension headache) that addressed efficacy or harms compared with usual care, no treatment, waitlist, placebo, or sham intervention; compared with pharmacological therapy; or compared with exercise. Study quality was assessed, data extracted, and results summarized for function and pain. Only trials reporting results for at least 1 month post-intervention were included. We focused on the persistence of effects at short term (1 to <6 months following treatment completion), intermediate term (≥6 to <12 months), and long term (≥12 months).

Results. Two hundred eighteen publications (202 trials) were included. Many included trials were small. Evidence on outcomes beyond 1 year after treatment completion was sparse. Most trials enrolled patients with moderate baseline pain intensity (e.g., >5 on a 0 to 10 point numeric rating scale) and duration of symptoms ranging from 3 months to >15 years. The most common comparison was against usual care.

Chronic low back pain: At short term, massage, yoga, and psychological therapies (primarily CBT) (strength of evidence [SOE]: moderate) and exercise, acupuncture, spinal manipulation, and multidisciplinary rehabilitation (SOE: low) were associated with slight improvements in function compared with usual care or inactive controls. Except for spinal manipulation, these interventions also improved pain.

Effects on intermediate-term function were sustained for yoga, spinal manipulation, multidisciplinary rehabilitation (SOE: low), and psychological therapies (SOE: moderate). Improvements in pain continued into intermediate term for exercise, massage, and yoga (moderate effect, SOE: low); mindfulness-based stress reduction (small effect, SOE: low); spinal manipulation, psychological therapies, and multidisciplinary rehabilitation (small effects, SOE: moderate). For acupuncture, there was no difference in pain at intermediate term, but a slight improvement at long term (SOE: low). Psychological therapies were associated with slightly greater improvement than usual care or an attention control on both function and pain at short-term, intermediate-term, and long-term followup (SOE: moderate). At short and intermediate term, multidisciplinary rehabilitation slightly improved pain compared with exercise (SOE: moderate). High-intensity multidisciplinary rehabilitation (≥20 hours/week or >80 hours total) was not clearly better than non–high-intensity programs.

Chronic neck pain: At short and intermediate terms, acupuncture and Alexander Technique were associated with slightly improved function compared with usual care (both interventions), sham acupuncture, or sham laser (SOE: low), but no improvement in pain was seen at any time (SOE: llow). Short-term low-level laser therapy was associated with moderate improvement in function and pain (SOE: moderate). Combination exercise (any 3 of the following: muscle performance, mobility, muscle re-education, aerobic) demonstrated a slight improvement in pain and function short and long term (SOE: low).

Osteoarthritis: For knee osteoarthritis, exercise and ultrasound demonstrated small short-term improvements in function compared with usual care, an attention control, or sham procedure (SOE: moderate for exercise, low for ultrasound), which persisted into the intermediate term only for exercise (SOE: low). Exercise was also associated with moderate improvement in pain (SOE: low). Long term, the small improvement in function seen with exercise persisted, but there was no clear effect on pain (SOE: low). Evidence was sparse on interventions for hip and hand osteoarthritis. Exercise for hip osteoarthritis was associated with slightly greater function and pain improvement than usual care short term (SOE: low). The effect on function was sustained intermediate term (SOE: low).

Fibromyalgia: In the short term, acupuncture (SOE: moderate), CBT, tai chi, qigong, and exercise (SOE: low) were associated with slight improvements in function compared with an attention control, sham, no treatment, or usual care. Exercise (SOE: moderate) and CBT improved pain slightly, and tai chi and qigong (SOE: low) improved pain moderately in the short term. At intermediate term for exercise (SOE: moderate), acupuncture, and CBT (SOE: low), slight functional improvements persisted; they were also seen for myofascial release massage and multidisciplinary rehabilitation (SOE: low); pain was improved slightly with multidisciplinary rehabilitation in the intermediate term (SOE: low). In the long term, small improvements in function continued for multidisciplinary rehabilitation but not for exercise or massage (SOE: low for all); massage (SOE: low) improved long-term pain slightly, but no clear impact on pain for exercise (SOE: moderate) or multidisciplinary rehabilitation (SOE: low) was seen. Short-term CBT was associated with a slight improvement in function but not pain compared with pregabalin.

Chronic tension headache: Evidence was sparse and the majority of trials were of poor quality. Spinal manipulation slightly improved function and moderately improved pain short term versus usual care, and laser acupuncture was associated with slight pain improvement short term compared with sham (SOE: low).

There was no evidence suggesting increased risk for serious treatment-related harms for any of the interventions, although data on harms were limited.

Conclusions. Exercise, multidisciplinary rehabilitation, acupuncture, CBT, and mind-body practices were most consistently associated with durable slight to moderate improvements in function and pain for specific chronic pain conditions. Our findings provided some support for clinical strategies that focused on use of nonpharmacological therapies for specific chronic pain conditions. Additional comparative research on sustainability of effects beyond the immediate post-treatment period is needed, particularly for conditions other than low back pain.

Author/s:

Skelly, Andrea C., Chou, Roger, Dettori, Joseph R., Turner, Judith A., Friedly, Janna L., Rundell, Sean D., Fu, Rongwei, Brodt, Erika D., Wasson, Ngoc, Winter, Cassandra, Ferguson, Aaron J. R.