Drug Therapy for the Treatment of Chronic
Nonspecific Low Back Pain: Systematic Review
and Meta-analysis

Background: Low back pain (LBP) is one of the most common health problems in adults. The impact of LBP on the individual can cause loss of health status in the form of symptoms and loss of function related to pain in the back; limitation of daily, leisure, and/or strenuous activities, and disability. LBP also poses an economic burden to society, mainly in terms of one of the most common reasons for seeking medical care (direct treatment costs), and accounts for the large number of work days lost (indirect costs). To reduce the impact of LBP on adults, drug therapy is the most frequently recommended intervention. Over the last decade, a substantial number of randomized clinical trials of drug therapy for LBP have been published. Objective: To determine the effectiveness of drug therapy for the treatment of chronic nonspecific low back pain (CNLBP). Study Design: Systematic review and meta-analysis Methods: A systematic review and meta-analysis of randomized controlled trials was conducted. Five databases (Medline, CINAHL, Science Direct, CAJ Full-text Database, and Cochrane databases) were searched for articles published from 2002 to 2012. The eligibility criteria were randomized trials and double-blind controlled trials of oral or injection drug therapy for CNLBP in subjects who were aged at least 18 years old, published in English or Chinese. Two independent reviewers extracted the data. Results: A total of 25 drug therapy trials were included. cyclo-oxygenase-2 (COX-2) nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, and opioids were commonly used. Only 5 trials studied the efficacy of adjuvant analgesics of antiepileptics (n = 1) and antidepressants (n = 4) for CNLBP. The standardized mean difference (SMD) for COX-2 NSAIDs in pain relief was -12.03 (95% confidence interval [CI]: -15.00 to -9.06). The SMD for tramadol in pain relief was -1.72 (95% CI: -3.45 to 0.01). As the 95% CI crossed 0, this effect size was not considered statistically significant. The SMD for the overall effects of opioids in pain relief was -5.18 (95% CI: -8.30 to -2.05). The SMD for the partial opioid agonist drug in pain relief was -7.46 (95% CI: -11.87 to -3.04). Limitations: The follow-up periods of these included trials in the meta-analysis ranged from 4 to 24 weeks. The difference of follow-up periods influenced how study outcomes were recorded. These included trials also had significant differences in patient selections. Some trials may actually include CNLBP patients with neuropathic pain, as not having focal neurological findings or signs does not mean that the pain is not neuropathic. Consequently, different pain conditions may influence patients who responded to the same drug and then influence pooled estimates of treatment effect size. Conclusion: This review endorses the use of COX-2 NSAIDs as the first-line drugs for CNLBP. Tramadol shows no statistically significant effect on pain relief, but has small effect sizes in improving functioning. Among included opioid therapy studies, the overall effects of opioids and the partial opioids agonist drug had statistically significant treatment effects in pain relief for CNLBP patients. Key words: NSAIDs, opioids, antidepressants, drug therapy, low back pain, systematic review, meta-analysis, randomized clinical trials

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Effectiveness of ozone therapy compared to other therapies for low back pain: a systematic review with meta-analysis of randomized clinical trials

Brazilian Journal of Anesthesiology (English Edition) ◽

10.1016/j.bjane.2019.06.007 ◽

2019 ◽

Vol 69 (5) ◽

pp. 493-501 ◽

Cited By ~ 1

Author(s):

Raul Ribeiro de Andrade ◽

Olavo Barbosa de Oliveira-Neto ◽

Luciano Timbó Barbosa ◽

Isabelle Oliveira Santos ◽

Célio Fernando de Sousa-Rodrigues ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Low Back Pain ◽

Back Pain ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Low Back ◽

Ozone Therapy

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Combination Drug Therapy for the Management of Low Back Pain and Sciatica: Systematic Review and Meta-Analysis

Journal of Pain ◽

10.1016/j.jpain.2018.06.005 ◽

2019 ◽

Vol 20 (1) ◽

pp. 1-15 ◽

Cited By ~ 11

Author(s):

Stephanie Mathieson ◽

Richard Kasch ◽

Christopher G. Maher ◽

Rafael Zambelli Pinto ◽

Andrew J. McLachlan ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Drug Therapy ◽

Meta Analysis ◽

Low Back ◽

Combination Drug Therapy ◽

Combination Drug

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Efficacy of Platelet-rich Plasma for Low Back Pain: A Systematic Review and Meta-analysis

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1709170 ◽

2020 ◽

Vol 81 (06) ◽

pp. 529-534 ◽

Cited By ~ 1

Author(s):

Zhaopeng Xuan ◽

Wenjun Yu ◽

Yichen Dou ◽

Tao Wang

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Patient Satisfaction ◽

Back Pain ◽

Pain Relief ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Low Back ◽

Pain Scores ◽

Control Intervention

Abstract Background Platelet-rich plasma (PRP) may be beneficial for patients with low back pain. However, the results remain controversial. We conducted a systematic review and meta-analysis to explore the efficacy of PRP for low back pain. Methods PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases were searched systematically. Randomized controlled trials (RCTs) assessing the effect of PRP on low back pain were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was pain scores within 8 weeks. Meta-analysis was performed using the random-effects model. Results Three RCTs involving 131 patients were included in the meta-analysis. Overall, compared with control intervention for low back pain, PRP injection was found to reduce pain scores significantly (mean difference: − 1.47; 95% confidence interval [CI], − 2.12 to − 0.81; p < 0.0001), improve the number of patients with > 50% pain relief at 3 months (risk ratio [RR]: 4.14; 95% CI, 2.22–7.74; p < 0.00001), and offer relatively good patient satisfaction (RR: 1.91; 95% CI, 1.04–3.53; p = 0.04). No increase in adverse events was reported after PRP injection (RR: 1.92; 95% CI, 0.94-3.91; p = 0.07). Conclusions Compared with control intervention for low back pain, PRP injection was found to improve pain relief and patient satisfaction significantly with no increase in adverse events.

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Virtual Reality in the Treatment of Adults with Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182211806 ◽

2021 ◽

Vol 18 (22) ◽

pp. 11806

Author(s):

Beatriz Brea-Gómez ◽

Irene Torres-Sánchez ◽

Araceli Ortiz-Rubio ◽

Andrés Calvache-Mateo ◽

Irene Cabrera-Martos ◽

...

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Chronic Low Back Pain ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Low Back

Virtual reality (VR) can present advantages in the treatment of chronic low back pain. The objective of this systematic review and meta-analysis was to analyze the effectiveness of VR in chronic low back pain. This review was designed according to PRISMA and registered in PROSPERO (CRD42020222129). Four databases (PubMed, Cinahl, Scopus, Web of Science) were searched up to August 2021. Inclusion criteria were defined following PICOS recommendations. Methodological quality was assessed with the Downs and Black scale and the risk of bias with the Cochrane Risk of Bias Assessment Tool. Fourteen studies were included in the systematic review and eleven in the meta-analysis. Significant differences were found in favor of VR compared to no VR in pain intensity postintervention (11 trials; n = 569; SMD = −1.92; 95% CI = −2.73, −1.11; p < 0.00001) and followup (4 trials; n = 240; SDM = −6.34; 95% CI = −9.12, −3.56; p < 0.00001); and kinesiophobia postintervention (3 trials; n = 192; MD = −8.96; 95% CI = −17.52, −0.40; p = 0.04) and followup (2 trials; n = 149; MD = −12.04; 95% CI = −20.58, −3.49; p = 0.006). No significant differences were found in disability. In conclusion, VR can significantly reduce pain intensity and kinesiophobia in patients with chronic low back pain after the intervention and at followup. However, high heterogeneity exists and can influence the consistency of the results.

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Ozone Therapy as a Treatment for Low Back Pain Secondary to Herniated Disc: A Systematic Review and Meta-analysis of Randomized Controlled Trials

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/e115 ◽

2012 ◽

Vol 2;15 (2;3) ◽

pp. E115-E129

Author(s):

Erich T. Fonoff

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Pain Relief ◽

Randomized Trials ◽

Meta Analysis ◽

Low Back ◽

Ozone Therapy ◽

Randomized Controlled

Background: Low back pain (LBP) is one of the most common and important health problems affecting the population worldwide and remains mostly unsolved. Ozone therapy has emerged as an additional treatment method. Questions persist concerning its clinical efficacy. Objective: The purpose of our study was to evaluate the therapeutic results of percutaneous injection of ozone for low back pain secondary to disc herniation. Study Design: A systematic review and meta-analysis of randomized controlled trials. Methods: A comprehensive literature search was conducted using all electronic databases from 1966 through September 2011. The quality of individual articles was assessed based on the modified Cochrane review criteria for randomized trials and criteria from the Agency for Healthcare Research and Quality. Outcome Parameters: The outcome measure was short-term pain relief of at least 6 months or long-term pain relief of more than 6 months. Results: Eight observational studies were included in the systematic review and 4 randomized trials in the meta-analysis. The indicated level of evidence for long-term pain relief was II-3 for ozone therapy applied intradiscally and II-1 for ozone therapy applied paravertebrally. The grading of recommendation was 1C for intradiscal ozone therapy and 1B for paravertebral ozone therapy. Limitations: The main limitations of this review are the lack of precise diagnosis and the frequent use of mixed therapeutic agents. The meta-analysis included mainly active-control trials. No placebo-controlled trial was found. Conclusions: Ozone therapy appears to yield positive results and low morbidity rates when applied percutaneously for the treatment of chronic low back pain. Key words: Low back pain, oxygen-ozone, ozone therapy, chronic pain, failed back surgery syndrome.

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Parasagittal Approach of Epidural Steroid Injection as a Treatment for Chronic Low Back Pain: A Systematic Review and Meta-Analysis

Frontiers in Pain Research ◽

10.3389/fpain.2021.676730 ◽

2021 ◽

Vol 2 ◽

Author(s):

Nebojsa Nick Knezevic ◽

Stephania Paredes ◽

Santiago Cantillo ◽

Albara Hamid ◽

Kenneth D. Candido

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Pain Relief ◽

Chronic Low Back Pain ◽

Steroid Injection ◽

Meta Analysis ◽

Low Back ◽

Post Procedure ◽

Epidural Steroid

Background: Epidural steroid injection (ESI) has proven benefits in controlling chronic low back pain and can be performed via the midline interlaminar (MIL) or transforaminal (TF) approach. A modified interlaminar approach, the parasagittal interlaminar (PIL), has surfaced as a more reliable, safe, and suitable approach to minimize complications related to MIL and TF.Objective: To conduct a systematic review and meta-analysis to assess and compare the effectiveness and safety of PIL with both MIL and TF approaches in adult patients with a history of chronic low back pain.Methods: A literature search was conducted using major electronic databases, such as PubMed, EMBASE, and Cochrane. Selected studies included patients with unilateral radicular symptoms, secondary to lumbar intervertebral disc hernias or degenerative lumbar disc disease, that, additionally, received ESIs via PIL or either MIL or TF under fluoroscopic guidance. Randomized and observational studies with pain relief score and/or functional disability assessment and at least a 2-week follow-up were included.Results: The search led to the initial identification of 174 studies. Following the screening, eight studies were included in the qualitative analysis and seven randomized controlled trials (RCTs) were included in the statistical analysis. PIL showed statistically significantly more pain relief and functional improvement than MIL at 1-, 3-, and 6-month post-procedure. Compared to TF, PIL showed statistically significantly more pain relief at 3- and 6-month after the procedure. Additionally, PIL showed benefits in terms of lower mean fluoroscopy time, less radiation exposure, zero adverse events in all the included studies, no cases of intravascular spread compared with the TF approach, and a higher anterior epidural spread (AES) of PIL compared with TF.Conclusions: Our systematic review and meta-analysis suggest that the PIL approach is an effective and safe alternative to the MIL and TF approaches in patients presenting with chronic low back pain when epidural injections are indicated, demonstrating a higher level of pain relief and a stronger improvement in functionality post-procedure.

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