Treatments for Back Pain: Can We Get Past Trivial Effects?

Editorials21 December 2004Treatments for Back Pain: Can We Get Past Trivial Effects?Richard A. Deyo, MD, MPHRichard A. Deyo, MD, MPHFrom University of Washington, Seattle, WA 98195.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-12-200412210-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The history of treatments for back and neck pain is generally one of small increments in benefit. For patients with acute pain, the natural history is favorable, and it is hard to prove that most treatments result in greater improvement than the nonspecific effects of natural history, placebo, and regression to the mean. The treatments that appear better than placebo, such as nonsteroidal anti-inflammatory drugs, muscle relaxants, and spinal manipulation, generally have modest effects (1-3). For chronic pain, the natural history is less favorable, but it is similarly difficult to prove that most treatments are better than nonspecific effects alone. ...References1. van Tulder MW, Scholten RJ, Koes BW, Deyo RA. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2000;:CD000396. [PMID: 10796356] MedlineGoogle Scholar2. van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. 2003;:CD004252. [PMID: 12804507] MedlineGoogle Scholar3. Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Ann Intern Med. 2003;138:871-81. [PMID: 12779297] LinkGoogle Scholar4. Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Majkowski GR, et al. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med. 2004;141:920-8. LinkGoogle Scholar5. White P, Lewith G, Prescott P, Conway J. Acupuncture versus placebo for the treatment of chronic mechanical neck pain. A randomized, controlled trial. Ann Intern Med. 2004;141:911-9. LinkGoogle Scholar6. Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services; 1994. AHCPR publication no. 95-0642. Google Scholar7. van Tulder MW, Malmivaara A, Esmail R, Koes BW. Exercise therapy for low back pain. Cochrane Database Syst Rev. 2000;:CD000335. [PMID: 10796344] MedlineGoogle Scholar8. van Tulder MW, Cherkin DC, Berman B, Lao L, Koes BW. Acupuncture for low-back pain. Cochrane Database of Systematic Reviews. 1999, Issue 2. CD001351. DOI: 10.1002/14651858.CD001351. Google Scholar9. Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Intern Med. 2003;138:898-906. [PMID: 12779300] LinkGoogle Scholar10. Kalauokalani D, Cherkin DC, Sherman KJ, Koepsell TD, Deyo RA. Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Spine. 2001;26:1418-24. [PMID: 11458142] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Washington, Seattle, WA 98195.Disclaimer: The opinions and conclusions herein are those of the author and not necessarily those of the National Institute for Arthritis, Musculoskeletal, and Skin Diseases.Grant Support: By the National Institute for Arthritis, Musculoskeletal, and Skin Diseases (No. P60 AR48093).Disclosures: None disclosed.Corresponding Author: Richard A. Deyo, MD, MPH, Box 357183, University of Washington, Seattle, WA 98195; e-mail, [email protected]washington.edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAcupuncture versus Placebo for the Treatment of Chronic Mechanical Neck Pain Peter White , George Lewith , Phil Prescott , and Joy Conway A Clinical Prediction Rule To Identify Patients with Low Back Pain Most Likely To Benefit from Spinal Manipulation: A Validation Study Maj John D. Childs , Julie M. Fritz , Timothy W. Flynn , James J. Irrgang , Maj Kevin K. Johnson , Maj Guy R. Majkowski , and Anthony Delitto Acupuncture for Chronic Mechanical Neck Pain Peter J. White and George Lewith Treatments for Back Pain John D. Childs , Julie M. Fritz , and Timothy W. 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White, PhD, BSc and George Lewith, DMTreatments for Back PainJohn D. Childs, PT, PhD, Julie M. Fritz, PhD, PT, and Timothy W. Flynn, PhD, PTResearch in Low Back Pain: Time to Stop Seeking the Elusive "Magic Bullet" 21 December 2004Volume 141, Issue 12Page: 957-958KeywordsAcupunctureDrugsExerciseExercise therapyLower back painMotivationPatientsRandomized trialsSafetySkin diseases ePublished: 21 December 2004 Issue Published: 21 December 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...