scholarly journals Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results From a Markov Model

Spine ◽  
2019 ◽  
Vol 44 (20) ◽  
pp. 1456-1464 ◽  
Author(s):  
Patricia M. Herman ◽  
Tara A. Lavelle ◽  
Melony E. Sorbero ◽  
Eric L. Hurwitz ◽  
Ian D. Coulter
Spine ◽  
2020 ◽  
Vol 45 (19) ◽  
pp. 1383-1385
Author(s):  
Patricia M. Herman ◽  
Ryan K. McBain ◽  
Nicholas Broten ◽  
Ian D. Coulter

Pain Medicine ◽  
2019 ◽  
Vol 20 (12) ◽  
pp. 2588-2597 ◽  
Author(s):  
Susan Lynn Murphy ◽  
Richard Edmund Harris ◽  
Nahid Roonizi Keshavarzi ◽  
Suzanna Maria Zick

Abstract Objective Chronic low back pain (CLBP) is associated with fatigue, pain, poor sleep, and disability. Acupressure is a low-risk treatment option used to manage symptoms in other groups, but its efficacy, particularly on fatigue and sleep, is unknown in CLBP. This study examined preliminary effects of two types of self-administered acupressure (relaxing and stimulating) on fatigue, pain, sleep, and reported disability. Methods A randomized pilot trial was conducted (N = 67) in which participants were randomized into six weeks of relaxing acupressure, stimulating acupressure, or usual care. Fatigue was measured by the Brief Fatigue Inventory, pain was measured by the Brief Pain Inventory, sleep was measured by the Pittsburgh Sleep Quality Index, and reported disability was measured by the Roland Morris Scale. Results Baseline characteristics were similar across groups. An intent-to-treat analysis using general linear models showed positive improvement in pain in acupressure groups compared with usual care. Pain was reduced by 35–36% in the acupressure groups. Improvement in fatigue was also found in stimulating acupressure compared with usual care. Adverse events were minimal and related to application of too much pressure. Discussion Although this was a small study, acupressure demonstrated promising preliminary support of efficacy for pain and fatigue reduction in this population.


2011 ◽  
Vol 155 (1) ◽  
pp. 1 ◽  
Author(s):  
Daniel C. Cherkin ◽  
Karen J. Sherman ◽  
Janet Kahn ◽  
Robert Wellman ◽  
Andrea J. Cook ◽  
...  

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Marielle E. J. B. Goossens ◽  
Reina J. A. de Kinderen ◽  
Maaike Leeuw ◽  
Jeroen R. de Jong ◽  
Joop Ruijgrok ◽  
...  

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e035461 ◽  
Author(s):  
Margreth Grotle ◽  
Lars Christian Bråten ◽  
Jens Ivar Brox ◽  
Ansgar Espeland ◽  
Zinajda Zolic-Karlsson ◽  
...  

ObjectiveTo evaluate the cost–utility of 100 days of antibiotics in patients with chronic low back pain (LBP) and type I or II Modic changes included in the Antibiotic treatment In patients with chronic low back pain and Modic changes (AIM) study.DesignA cost–utility analysis from a societal and healthcare perspective alongside a double-blinded, parallel group, placebo, multicentre trial.SettingHospital outpatient clinics at six hospitals in Norway. The main results from the AIM study showed a small effect in back-related disability in favour of the antibiotics group, and slightly larger in those with type I Modic changes, but this effect was below the pre-defined threshold for clinically relevant effect.Participants180 patients with chronic LBP, previous disc herniation and Modic changes type I (n=118) or type II (n=62) were randomised to antibiotic treatment (n=89) or placebo-control (n=91).InterventionsOral treatment with either 750 mg amoxicillin or placebo three times daily for 100 days.Main outcome measuresQuality-adjusted life years (QALYs) by EuroQoL-5D over 12 months and costs for healthcare and productivity loss measured in Euro (€1=NOK 10), in the intention-to-treat population. Cost–utility was expressed in incremental cost-effectiveness ratio (ICER).ResultsMean (SD) total cost was €21 046 (20 105) in the amoxicillin group and €19 076 (19 356) in the placebo group, mean difference €1970 (95% CI; −3835 to 7774). Cost per QALY gained was €24 625. In those with type I Modic changes, the amoxicillin group had higher healthcare consumption than the placebo group, resulting in €39 425 per QALY gained. Given these ICERs and a willingness-to-pay threshold of €27 500 (NOK 275 000), the probability of amoxicillin being cost-effective was 51%. Even when the willingness-to-pay threshold increased to €55 000, the probability of amoxicillin being cost-effective was never higher than 53%.ConclusionsAmoxicillin treatment showed no evidence of being cost-effective for people with chronic LBP and Modic changes during 1-year follow-up.Trial registration numberClinicalTrials.gov NCT02323412.


2019 ◽  
Vol 39 ◽  
pp. 178-183 ◽  
Author(s):  
Tomohiko Nishigami ◽  
Benedict Martin Wand ◽  
Roger Newport ◽  
Natasha Ratcliffe ◽  
Kristy Themelis ◽  
...  

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