Back Pain

Jul 15, 2018 Issue
Physical Therapy for Low Back Pain [FPIN's Clinical Inquiries]

There is some evidence that early physical therapy may decrease posttreatment health care utilization for low back pain.

May 1, 2018 Issue
Lumbar Fusion of Variable Value Based on Treating Diagnosis, with Significant Complication Rates [POEMs]

Lumbar fusion for degenerative spinal disease appears to be most beneficial for patients undergoing the procedure for spondylolisthesis, but it is of little clear benefit for patients with other indications, such as spinal stenosis or chronic back pain.

Apr 1, 2018 Issue
Early PT for Acute Low Back Pain Is Cost-Effective, but Gain in Quality of Life Is Likely Too Small to Notice [POEMs]

At $30,000 per quality-adjusted life year (QALY) gained, early PT for acute low back pain in primary care is cost-effective by the usual criteria of $50,000 to $100,000 per QALY. However, the magnitude of improvement in quality of life is small and is probably not clinically meaningful.

Dec 15, 2017 Issue
Gabapentinoids for Chronic Low Back Pain: Limited Evidence, More Harm Than Benefit [POEMs]

The existing data on gabapentinoids for chronic low back pain are limited in number and quality. The amount of pain reduction is low to moderate, and the rate of adverse effects is high. The few studies that assessed function found no improvement.

Sep 15, 2017 Issue
Low Back Pain: American College of Physicians Practice Guideline on Noninvasive Treatments [Practice Guidelines]

The American College of Physicians has released a guideline, which partially updates its 2007 guideline, to provide recommendations for noninvasive treatment of acute (duration less than four weeks), subacute (duration of four to 12 weeks), and chronic (duration longer than 12 weeks) low back pain. It does not address topical or epidural therapies.

Sep 1, 2017 Issue
Noninvasive Treatments for Low Back Pain [Implementing AHRQ Effective Health Care Reviews]

What are the benefits and harms of noninvasive treatments for acute, subacute, and chronic low back pain?

Aug 15, 2017 Issue
Pregabalin Does Not Decrease the Pain of Sciatica [POEMs]

Pregabalin does not relieve pain in patients with sciatica.

Apr 1, 2017 Issue
Placebo Plus Message of Benefit Decreases Chronic Low Back Pain [POEMs]

These investigators gave twice daily placebo to patients with chronic back pain and told them it was placebo. They also told them that placebos can have a pronounced effect (which is true). The addition of placebo to usual care improved patients' pain and disability scores over the three weeks of the study.

Dec 1, 2016 Issue
Lumbar Fusion No Better Than Exercise and Therapy in the Long Term [POEMs]

This trial is a good example of how to do just about everything wrong to get the results you want. The authors did not conceal allocation, did not mask anyone in the study, used an unvalidated and subjective primary outcome, and downplayed the intention-to-treat analysis. Funding for the original st...

Nov 1, 2016 Issue
Opioid Analgesia Hard to Tolerate and Not Effective for Chronic Low Back Pain [POEMs]

Effective pain control in patients with low back pain is still elusive. Approximately one-half of all patients with low back pain who take an opioid analgesic will stop treatment because of ineffectiveness or adverse effects. Patients staying the course will experience, on average, a small decrease ...

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