A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain

Background. Back pain is a common problem and a major cause of disability and health care utilization.Purpose. To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain.Data Sources. Records without language restriction from various databases up to February 2010.Data Extraction. The efficacy outcomes of interest were pain intensity and disability.Data Synthesis. Reports of 147 randomized trials and 5 nonrandomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically nonsignificant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature.Conclusions. CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments.

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Systematic review and meta-analysis of effects of acupuncture on pain and function in non-specific low back pain

Acupuncture in Medicine ◽

10.1136/acupmed-2017-011622 ◽

2020 ◽

Vol 38 (4) ◽

pp. 235-243

Author(s):

Yun-xia Li ◽

Su-e Yuan ◽

Jie-qiong Jiang ◽

Hui Li ◽

Yue-jiao Wang

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Usual Care ◽

Meta Analysis ◽

Functional Improvement ◽

Controlled Trials ◽

Low Back ◽

Short Term ◽

Significant Difference

Objective: To assess the effectiveness of acupuncture for non-specific low back pain (NSLBP) through systematic review of published randomised controlled trials (RCTs). Methods: Studies were identified in electronic databases from their inception to February 2018, and were grouped according to the control interventions. The outcomes of interest were pain intensity and disability. Methodological quality was evaluated using the Cochrane risk-of-bias criteria and the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) checklist. The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: 25 trials (n=7587 participants) were identified and included in a meta-analysis. The results showed that acupuncture was more effective at inducing pain relief than: no treatment (standardised mean difference (SMD) −0.69, 95% CI −0.99 to −0.38); sham acupuncture in the immediate term (SMD −0.33, 95% CI −0.49 to −0.18), short term (SMD −0.47, 95% CI −0.77 to −0.17), and intermediate term (SMD −0.17, 95% CI −0.28 to −0.05); and usual care in the short term (SMD −1.07, 95% CI −1.81 to −0.33) and intermediate term (SMD −0.43, 95% CI −0.77 to −0.10). Also, adjunctive acupuncture with usual care was more effective than usual care alone at all time points studied. With regard to functional improvement, the analysis showed a significant difference between acupuncture and no treatment (SMD −0.94, 95% CI −1.57 to −0.30), whereas the other control therapies could not be assessed. Conclusion: We draw a cautious conclusion that acupuncture appears to be effective for NSLBP and that acupuncture may be an important supplement to usual care in the management of NSLBP.

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Faculty Opinions recommendation of Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717969063.793468611 ◽

2013 ◽

Author(s):

Steven George ◽

Jason Beneciuk

Keyword(s):

Primary Care ◽

Health Care ◽

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Health Care Utilization ◽

Care Utilization ◽

Low Back ◽

Future Health ◽

Future Health Care

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Intervertebral disc therapies for non-specific chronic low back pain: a systematic review and meta-analysis

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x211028001 ◽

2021 ◽

Vol 13 ◽

pp. 1759720X2110280

Author(s):

Camille Daste ◽

Stéphanie Laclau ◽

Margaux Boisson ◽

François Segretin ◽

Antoine Feydy ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Intervertebral Disc ◽

Chronic Low Back Pain ◽

Meta Analysis ◽

Activity Limitations ◽

Low Back ◽

Short Term

Objectives: We aim to evaluate the benefits and harms of intervertebral disc therapies (IDTs) in people with non-specific chronic low back pain (NScLBP). Methods: We conducted a systematic review and meta-analysis of randomized trials of IDTs versus placebo interventions, active comparators or usual care. EMBASE, MEDLINE, CENTRAL and CINHAL databases and conference abstracts were searched from inception to June 2020. Two independent investigators extracted data. The primary outcome was LBP intensity at short term (1 week–3 months), intermediate term (3–6 months) and long term (after 6 months). Results: Of 18 eligible trials (among 1396 citations), five assessed glucocorticoids (GCs) IDTs and were included in a quantitative synthesis; 13 assessed other products including etanercept ( n = 2), tocilizumab ( n = 1), methylene blue ( n = 2), ozone ( n = 2), chymopapaine ( n = 1), glycerol ( n = 1), stem cells ( n = 1), platelet-rich plasma ( n = 1) and recombinant human growth and differentiation factor-5 ( n = 2), and were included in a narrative synthesis. Standardized mean differences (95% CI) for GC IDTs for LBP intensity and activity limitations were −1.33 (−2.34; −0.32) and −0.76 (−1.85; 0.34) at short term, −2.22 (−5.34; 0.90) and −1.60 (−3.51; 0.32) at intermediate term and −1.11 (−2.91; 0.70) and −0.63 (−1.68; 0.42) at long term, respectively. Odds ratios (95% CI) for serious and minor adverse events with GC IDTs were 1.09 (0.25; 4.65) and 0.97 (0.49; 1.91). Conclusion: GC IDTs are associated with a reduction in LBP intensity at short term in people with NScLBP. Positive effects are not sustained. IDTs have no effect on activity limitations. Our conclusions are limited by high heterogeneity and a limited methodological quality across studies. Registration PROSPERO: CRD42019106336.

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IMPACT OF TIMING OF PHYSICAL THERAPY ON HEALTH CARE UTILIZATION AND COSTS AMONG PATIENTS WITH ACUTE LOW BACK PAIN: EVIDENCE FROM NEW YORK STATE

Value in Health ◽

10.1016/j.jval.2016.03.1118 ◽

2016 ◽

Vol 19 (3) ◽

pp. A240

Author(s):

X. Liu ◽

W. Hanney ◽

M. Masaracchio

Keyword(s):

Health Care ◽

New York ◽

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

New York State ◽

Care Utilization ◽

Low Back ◽

York State ◽

Acute Low Back Pain

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Meditation for adults with non-specific low back pain: a systematic review and meta-analysis

Scandinavian Journal of Pain ◽

10.1515/sjpain-2021-0096 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Larissa O. Soares ◽

Giovanni E. Ferreira ◽

Leonardo O. P. Costa ◽

Leandro C. Nogueira ◽

Ney Meziat-Filho ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Usual Care ◽

Pain Intensity ◽

Cochrane Library ◽

Low Back ◽

Short Term ◽

Minimal Intervention ◽

Better Than

Abstract Objectives We aim to determine the effectiveness of meditation for adults with non-specific low back pain. Methods We searched PubMed, EMBASE, PEDro, Scopus, Web of Science, Cochrane Library, and PsycINFO databases for randomized controlled trials that investigated the effectiveness of meditation in adults with non-specific low back pain. Two reviewers rated risk of bias using the PEDro scale and the certainty of the evidence using the GRADE approach. Primary outcomes were pain intensity and disability. Results We included eight trials with a total of 1,234 participants. Moderate-certainty evidence shows that meditation is better than usual care for disability at short-term (SMD = −0.22; 95% CI = −0.42 to −0.02). We also found that meditation is better than usual care for pain intensity at long-term (SMD = −0.28; 95% CI = −0.54 to −0.02). There is no significant difference for pain intensity between meditation and minimal intervention or usual care at short and intermediate-term. We did not find differences between meditation and minimal intervention for disability at intermediate-term or usual care in any follow-up period. Conclusions We found small effect sizes and moderate-certainty evidence that meditation is slightly better than minimal intervention in the short-term for disability. Low-certainty of evidence suggests that meditation is slightly better than usual care for pain in the long-term. Meditation appears to be safe with most trials reporting no serious adverse events.

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The short-term effects of balneotherapy on pain, disability and fatigue in patients with chronic low back pain treated with physical therapy: A randomized controlled trial

Complementary Therapies in Medicine ◽

10.1016/j.ctim.2020.102550 ◽

2020 ◽

Vol 54 ◽

pp. 102550

Author(s):

Erdal Dilekçi ◽

Kağan Özkuk ◽

Barış Kaki

Keyword(s):

Randomized Controlled Trial ◽

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Chronic Low Back Pain ◽

Controlled Trial ◽

Low Back ◽

Short Term ◽

Randomized Controlled ◽

Pain Disability

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Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs

Physical Therapy ◽

10.1093/ptj/pzy023 ◽

2018 ◽

Vol 98 (5) ◽

pp. 336-347 ◽

Cited By ~ 19

Author(s):

Xinliang Liu ◽

William J Hanney ◽

Michael Masaracchio ◽

Morey J Kolber ◽

Mei Zhao ◽

...

Keyword(s):

Health Care ◽

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Health Care Utilization ◽

Care Utilization ◽

Low Back ◽

Acute Low Back Pain ◽

Therapy Initiation

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Associations Between Physical Therapy Continuity of Care and Health Care Utilization and Costs in Patients With Low Back Pain: A Retrospective Cohort Study

Physical Therapy ◽

10.1093/ptj/pzy103 ◽

2018 ◽

Vol 98 (12) ◽

pp. 990-999 ◽

Cited By ~ 4

Author(s):

John Magel ◽

Jaewhan Kim ◽

Anne Thackeray ◽

Charles Hawley ◽

Sterling Petersen ◽

...

Keyword(s):

Health Care ◽

Cohort Study ◽

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Continuity Of Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Care Utilization ◽

Low Back

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Acupuncture for Low Back Pain: An Overview of Systematic Reviews

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2015/328196 ◽

2015 ◽

Vol 2015 ◽

pp. 1-18 ◽

Cited By ~ 20

Author(s):

Lizhou Liu ◽

Margot Skinner ◽

Suzanne McDonough ◽

Leon Mabire ◽

George David Baxter

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Systematic Reviews ◽

External Validity ◽

Internal Validity ◽

Sham Acupuncture ◽

Functional Improvement ◽

Favorable Effect ◽

Low Back ◽

Short Term

Objective. As evidence of the effectiveness of acupuncture for low back pain (LBP) is inconsistent, we aimed to critically appraise the evidence from relevant systematic reviews.Methods. Systematic reviews of randomized controlled trials (RCTs) concerning acupuncture and LBP were searched in seven databases. Internal validity and external validity of systematic reviews were assessed. Systematic reviews were categorized and high quality reviews assigned greater weightings. Conclusions were generated from a narrative synthesis of the outcomes of subgroup comparisons.Results. Sixteen systematic reviews were appraised. Overall, the methodological quality was low and external validity weak. For acute LBP, evidence that acupuncture has a more favorable effect than sham acupuncture in relieving pain was inconsistent; it had a similar effect on improving function. For chronic LBP, evidence consistently demonstrated that acupuncture provides short-term clinically relevant benefits for pain relief and functional improvement compared with no treatment or acupuncture plus another conventional intervention.Conclusion. Systematic reviews of variable quality showed that acupuncture, either used in isolation or as an adjunct to conventional therapy, provides short-term improvements in pain and function for chronic LBP. More efforts are needed to improve both internal and external validity of systematic reviews and RCTs in this area.

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