Paracetamol. Acupuncture. Massage. Muscle relaxants. Cannabinoids Opiates The list of treatments available for lumbar pain is endless. However, According to a new study that summarizes the results of hundreds of randomized trials, there are no solid evidence that these treatments really reduce pain.
It is estimated that low back pain affects one in four American adults and is the main disability factor worldwide. In most cases diagnosed, pain is considered “indeterminate”, which means that it does not have a clear cause. That is also, in part, what makes it so difficult to treat.
In the study, Posted on Tuesday In the magazine BMJ Evidence-Based Medicine, the researchers reviewed 301 randomized trials that compared 56 non-invasive treatment for low back pain, such as medicines and exercise, with placebos. They used a statistical method to combine the results of these studies and obtain conclusions, a process known as meta -analysis.
The researchers discovered that only a treatment – the use of non -steroidal anti -inflammatories, or NSAIDs, such as ibuprofen and aspirin – was effective in reducing short -term, or acute lower back pain. Five other treatments had sufficient evidence to be considered effective in reducing chronic low back pain. These were exercise; the handling of the spine, such as the one that can perform a chiropractic; the bandage of the lumbar zone; antidepressants; and the application of a cream that creates a sensation of heat. And yet the benefit was small.
“The great conclusion of this work is that low back pain is exceptionally difficult to deal with,” said Steve Davidson, associate director of the Pain Research Center at New York University, who did not participate in the study. “They found that a few treatments are effective, but those who were have a marginal clinical efficacy.”
There were good evidence, for example, that exercise can reduce chronic back pain. But on a pain scale from 0 to 100, pain intensity was only reduced by an average of 7.9 points; less than what most doctors consider a clinically significant difference.
Let’s say a patient values his pain in 7 points of 10, said Prasad Shirvalkar, associate professor of pain medicine at California at San Francisco. “If I tell you: ‘What if I could get that 7 to 6.3? Wouldn’t it be great?” He said. “Not really. And that’s the effect size.”
David Clark, professor of anesthesia at the Stanford Faculty of Medicine and a medical specialist at the Palo Alto Veterans Medical Center, said the results coincided with his experience as a doctor. “Almost nothing we try works very well for patients,” he said.
However, both he and other experts said the study confirmed that some common therapies can provide moderate relief.
For example, said Shirvalkar, there are many different types of non -steroidal anti -inflammatories, and they may not take advantage of enough. “People could try two or three of them and have side effects, but doctors don’t try others,” he said.
And although the magnitude of the effect was small, doctors continue to believe that the exercise is likely to help with long -term back pain. The trunk exercises, such as plates, help strengthen the muscles that, in turn, hold the spine, said Shirvalkar. In addition, exercise has other benefits apart from reducing pain intensity, Clark explained, such as improving strength, mobility and mood and reducing the impact of pain when performing a task.
Aidan Cashin, first author of the study and deputy director of the Center for Pain Impact Research Group of Neuroscience Research Australia, said that the objective of the investigation was to identify which first -line treatments for low back pain had some specific effect beyond the placebo, which ones could merit to be more studied and which might not be worth continuing to explore. There were reliable evidence, for example, that paracetamol (acetaminophen) does not do much, or practically nothing, for acute low back pain.
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The study included a long list of treatments for which the tests were “non -conclusive” because the number of participants studied was too small or there was a high risk of bias in the investigation.
That does not necessarily mean that these treatments are ineffective, experts said. A limitation of the type of analysis that Cashin performed was that it used data from different studies and different populations to emulate a great essay. But in the process, a strong signal of a study that showed that a treatment worked could be diluted among the noise of other studies that could not have been designed optimally, he explained.
For example, the review found that the interventions tests such as heat (of a thermal pad, for example), massage and acression were of low certainty, but those treatments reduced the intensity of pain in around 20 points.
Doctors said that the evidence of something like heat could not be conclusive, but they would still recommend to patients to prove it. “It’s cheap, accessible and hardly causes damage,” said Shirvalkar.
Davidson explained that the treatments for which there were non -conclusive evidence offered a starting point to continue investigating.
“What shows that list is that we have options to work in terms of exploring different ways of treating low back pain,” he said.