Latest news with #BMJEvidence-BasedMedicine
Straits Times
27-05-2025
- Health
- Straits Times
What works for low back pain? Not much, a new study says
Low back pain affects an estimated one in four American adults and is the leading contributor to disability globally. PHOTO ILLUSTRATION: PIXABAY NEW YORK – Acetaminophen. Acupuncture. Massage. Muscle relaxants. The list of available treatments for low back pain goes on and on . But there is no good evidence that these treatments actually reduce the pain, according to a new study that summarised the results of hundreds of randomised trials. Low back pain affects about one in four American adults and is the leading contributor to disability globally. In most diagnosed cases, the pain is considered 'non-specific', meaning it does not have a clear cause. That is also partly what makes it so hard to treat. In the study published in the journal BMJ Evidence-Based Medicine in March, researchers reviewed 301 randomised trials that compared 56 non-invasive treatments for low back pain, like medications and exercise, with placebos. They used a statistical method to combine the results of those studies and draw conclusions, a process known as a meta-analysis. They found that only one treatment – the use of non-steroidal anti-inflammatory drugs, or NSAIDs, like ibuprofen and aspirin – was effective at reducing short-term, or acute, low back pain. Five other treatments had good enough evidence to be considered effective at reducing chronic low back pain. These were exercise; spinal manipulation, like you might receive from a chiropractor; taping the lower back; antidepressants; and the application of a cream that creates a warming sensation. Even so, the benefit was small. 'The big takeaways from this paper are that low back pain is exceptionally difficult to treat,' said Dr Steve Davidson, associate director of the NYU Pain Research Center, who was not involved in the study. 'There are a few treatments that they found that were effective, but those that were effective are marginally clinically effective.' There was good evidence, for example, that exercise can reduce chronic back pain. But it reduced the intensity of pain by only an average of 7.9 points on a 0-to-100 pain scale – less than what most doctors consider to be a clinically meaningful difference. Say a patient rates his or her pain as seven out of 10, said Dr Prasad Shirvalkar, an associate professor of pain medicine at the University of California, San Francisco. 'If I tell you, 'What if I could get you to a 6.3 from that 7? Wouldn't that be great?'' he said. 'Not really. And that's the effect size.' Dr David Clark, a professor of anaesthesia at Stanford Medicine and a pain physician at the Palo Alto VA Medical Center, said the findings aligned with his experience as a practitioner. 'Most of what we try does not work very well for patients,' he said. Still, he and other experts said the study affirmed that some common therapies may provide moderate relief. For example, Dr Shirvalkar said, there are many types of NSAIDs, and it is possible they are underused. 'People might try two or three of them and have side effects, but doctors don't try other ones,' he said. Although the magnitude of the effect was small, doctors still believe that exercise is likely to help with back pain in the long term. Core exercises, such as planks, help strengthen muscles that in turn support the spine, Dr Shirvalkar said. Exercise has benefits aside from lowering pain intensity, Dr Clark said, like improving strength, mobility and mood, and reducing the extent to which pain interferes with a task. Dr Aidan Cashin is the paper's first author and deputy director of the research group Center for Pain Impact at Neuroscience Research Australia. He said the aim of the study was to identify which first-line treatments for low back pain had any specific effects beyond a placebo, which might merit further study and which may not be worth pursuing. There was good evidence, for example, that paracetamol (acetaminophen) does little to nothing for acute low back pain. The study included a long list of treatments for which the evidence was 'inconclusive' because the number of participants studied was too small or there was a strong risk of bias in the research. That does not necessarily mean those treatments are ineffective, experts said. One limitation of the type of analysis that Dr Cashin conducted was that it aggregated data from different studies and different populations in order to emulate one large trial. But in the process, a strong signal from one study that a treatment worked could be diluted amid noise from other studies that may not have been designed as well, he said. For example, the review found that the evidence for interventions like heat (such as from a heating pad), massage and acupressure was of low certainty, but those treatments reduced the intensit y of pain by about 20 points. The evidence for something like heat might be inconclusive, but doctors would still recommend that patients try it. 'It's cheap; it's accessible; it almost causes no harm,' Dr Shirvalkar said. Dr Davidson said the treatments for which there was inconclusive evidence offered a starting point for more research. 'What that list shows is that we have things to work with in terms of looking at different ways to treat low back pain,' he said. NYTIMES Join ST's Telegram channel and get the latest breaking news delivered to you.
New York Times
27-03-2025
- Health
- New York Times
What Works for Low Back Pain? Not Much, a New Study Says.
Acetaminophen. Acupuncture. Massage. Muscle relaxants. Cannabinoids. Opioids. The list of available treatments for low back pain goes on and on. But there's not good evidence that these treatments actually reduce the pain, according to a new study that summarized the results of hundreds of randomized trials. Low back pain affects an estimated one in four American adults and is the leading contributor to disability globally. In most diagnosed cases, the pain is considered 'nonspecific,' meaning it doesn't have a clear cause. That's also partly what makes it so hard to treat. In the study, published on Tuesday in the journal BMJ Evidence-Based Medicine, researchers reviewed 301 randomized trials that compared 56 noninvasive treatments for low back pain, like medications and exercise, with placebos. They used a statistical method to combine the results of those studies and draw conclusions, a process known as a meta-analysis. The researchers found that only one treatment — the use of nonsteroidal anti-inflammatory drugs, or NSAIDs, like ibuprofen and aspirin — was effective at reducing short-term, or acute, low back pain. Five other treatments had good enough evidence to be considered effective at reducing chronic low back pain. These were exercise; spinal manipulation, like you might receive from a chiropractor; taping the lower back; antidepressants; and the application of a cream that creates a warming sensation. Even so, the benefit was small.
Telegraph
26-03-2025
- Health
- Telegraph
Placebo pills can improve women's PMS symptoms
Placebo pills can improve women's PMS symptoms, a study has found. The trial involving 150 women found that placebo pills were more effective than standard treatments for the symptoms of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). PMS is the umbrella term given to the symptoms women can experience in the weeks before their period, which includes mood swings, depression, tiredness and bloating. Researchers from the University of Basel in Switzerland split the group of women ages between 18 and 45 with PMS symptoms into three groups. One group was given standard treatment, which can include antidepressants and hormone-based pills such as oral contraceptives. The second group was given a placebo pill without being told, while a third was given the placebo and told it was a placebo – known as an open-label placebo – along with an explanation as to why it may help. Previous studies have shown the potential for open-label placebos – which are typically sugar pills and have no active ingredients – to help with conditions such as IBS, chronic lower back pain, ADHD, depression and menopausal hot flushes. The third group, who were given the open-label placebo and told it had no active medication, had the best response on every metric, the researchers said. Standard treatments were least effective The pills were taken twice a day for six weeks and the women in this group saw an average 79.3 per cent reduction in their symptom intensity and 82.5 per cent fall in interference in their lives. They also had the highest decrease (70.7 per cent) of psychological symptom intensity between menstrual cycles. Meanwhile, women receiving just the placebo without the explanation reported a 50.4 per cent reduction in symptoms, a 50.3 per cent drop in interference in their lives and a 42.6 per cent fall in mental health symptoms. Those who received standard treatments reported the smallest improvements of the three groups. Symptoms within this group were reduced by 33 per cent, interference in daily lives was 45.7 per cent lower, and psychological symptoms decreased by just 29.1 per cent. While the 'placebo effect' is a well-known concept that describes the benefits a patient feels from a treatment that cannot be attributed to the placebo itself, it is even less clear why telling someone they are taking a placebo may help. The researchers suggest the expectation created by an explanation could provide a boost, giving women a 'sense of autonomy and empowerment'. The authors of the study, which is published in the BMJ Evidence-Based Medicine journal, acknowledged that there were limitations in the design of the trial. The trial had been advertised as a study for a side-effect free intervention for PMS, which may have attracted participants who were more open to unconventional treatments or those who were dissatisfied with existing treatments. Results were also reliant on people's accurate reporting of their own symptoms. The researchers concluded that supplying open-label placebos 'with a treatment rationale to women with PMS can decrease symptom intensity and interference considerably in the absence of substantial side-effects and with full transparency'. They said the treatments 'could serve as an acceptable, efficacious and safe intervention for PMS'.
Jordan News
25-03-2025
- Health
- Jordan News
Non-Surgical Treatments Are Not Very Effective for Lower Back ...
اضافة اعلان Acetaminophen pills, acupuncture, massage, muscle relaxants, cannabinoids, and opioids—these are a list of treatments available for long-term lower back pain. However, there is no strong evidence that these treatments actually relieve pain, according to a new study that summarized the results of hundreds of randomized trials, as written by Nina Back Pain Lower back pain affects an estimated one in four American adults and is the leading cause of disability globally. In most diagnosed cases, the pain is 'nonspecific,' meaning there is no clear cause, which partly contributes to the difficulty in treating of Non-Surgical Treatments In the study published this month in BMJ Evidence-Based Medicine, researchers reviewed 301 randomized trials comparing 56 non-surgical treatments for lower back pain, such as medications and exercises, against placebos. The researchers used statistical methods to combine the results of these studies and draw conclusions, a process known as a of Ibuprofen and Aspirin The researchers found that only one treatment, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin, was effective in relieving short-term or acute lower back Treatments with Little Benefit Meanwhile, five other treatments showed sufficient evidence of being good for relieving chronic lower back pain, though the benefit was small. These treatments included: exercise, spinal manipulation as performed by a chiropractor, lower back patches, antidepressants, and creams that provide a warming sensation. However, the benefits were Davidson, Associate Director of the Pain Research Center at New York University, who did not participate in the study, said: 'The key takeaway from this study is that lower back pain is extremely difficult to treat. There are some treatments that were found to be effective, but those that were effective had minimal clinical benefit.'For example, there was strong evidence that exercise could reduce chronic back pain, but it only reduced pain intensity by an average of 7.9 points on a 0-100 pain scale, which is less than what most doctors consider a clinically significant Prasad Shervalkar, Assistant Professor of Pain Medicine at the University of California, San Francisco, said: 'Let's say a patient rates their pain as a 7 out of 10. If I told you, 'What if I could get you to a 6.3 out of 7?' Wouldn't that be great? Not really. And that's the size of the effect.'Dr. David Clark, Professor of Anesthesia at Stanford University School of Medicine and pain specialist at the Palo Alto Medical Center, said the results align with his experience as a practitioner. He added: 'Most of what we try doesn't work with patients.'Providing 'Moderate Relief' However, he and other experts stressed that the study confirmed some common treatments could provide moderate example, Shervalkar said there are many types of NSAIDs, and they may not be used sufficiently. He added: 'People may try two or three types and suffer side effects, but doctors don't try others.'Exercise Eases Pain Although the effect size of exercise was small, doctors still believe it likely helps alleviate back pain in the long term. Shervalkar said core exercises, like planks, help strengthen the muscles supporting the spine. Clark added that exercise has benefits beyond reducing pain intensity, such as improving strength, mobility, mood, and reducing the impact of pain on task Cashin, lead author of the study and Deputy Director of the Pain Impact Center at the Neuroscience Research Center in Australia, said the goal of the study was to identify initial treatments for lower back pain that have effects beyond placebo, which may warrant further study and those that do not. For example, there was strong evidence that paracetamol (acetaminophen) was not effective in treating acute lower back study included a long list of treatments for which the evidence was 'uncertain' due to a low number of participants or potential significant bias in the confirmed that this does not necessarily mean these treatments are ineffective. One flaw of the type of analysis Cashin conducted was that it pooled data from different studies and populations to simulate one large-scale trial. But in this process, a strong signal from one study about the effectiveness of a treatment might be drowned out by noise from studies that were perhaps not well designed, according to Massage, and Acupuncture For example, the review found that the evidence for interventions like heat (using a heating pad), massage, and acupuncture was of low certainty, but these treatments reduced pain intensity by about 20 said the evidence for treatments like heat might be inconclusive, but they still recommend patients try it. Shervalkar said: 'It's cheap; it's available; it almost doesn't cause any harm.'Davidson said treatments with inconclusive evidence represent a starting point for further research. He added: 'What this list shows is that we have potential to work with regarding exploring different ways to treat lower back pain.'New York Times Service
Yahoo
20-03-2025
- Health
- Yahoo
Just 1 in 10 back pain treatments work, study says — what to do instead
Chronic back pain is the most common type of pain, affecting around 16 million American adults — and now a new study has revealed some discouraging findings about potential treatments. Only around one in every 10 treatments was found to be effective in relieving lower back pain, according to a new study published in BMJ Evidence-Based Medicine. Many of them are "barely better than a placebo" in terms of pain relief, as stated in a press release from the University of New South Wales (UNSW) in Sydney, Australia. 'Dead Butt Syndrome' Could Happen After Sitting Too Long, Here's How To Avoid The Condition "Our review did not find reliable evidence of large effects for any of the included treatments," said lead study author Dr. Aidan Cashin, deputy director of the Centre for Pain IMPACT at Neuroscience Research Australia (NeuRA) and conjoint senior lecturer in the School of Health Sciences at UNSW Sydney. The researchers reviewed 301 randomized, controlled trials that included data on 56 non-surgical treatments for adults experiencing acute low back pain, chronic low back pain or a combination of both types, comparing them to groups that received placebos. Read On The Fox News App "Treatments included in the research were pharmacological, such as non-steroidal anti-inflammatory drugs – or NSAIDs – and muscle relaxants, but also non-pharmacological, like exercise and massage," Cashin said. Ineffective treatments for acute low back pain included exercise, steroid injections and paracetamol (acetaminophen), the study found. For chronic low back pain, antibiotics and anaesthetics were also "unlikely to be suitable treatment options," the study found. For acute low back pain, non-steroidal anti-inflammatory drugs (NSAIDs) could be effective, the study found. For chronic low back pain, therapies including exercise, taping, spinal manipulation, antidepressants and transient receptor potential vanilloid 1 (TRPV1) agonists may be effective — "however, those effects were small," Cashin noted. The findings were "inconclusive" for many other treatments due to the "limited number of randomized participants and poor study quality," the researchers stated. "We need further high-quality, placebo-controlled trials to understand the efficacy of treatments and remove the uncertainty for both patients and clinical teams," Cashin said. Dr. Stephen Clark, a physical therapist and chief clinical officer at Confluent Health in Georgia, noted that the study was looking at "isolated interventions." "They excluded studies where it was not possible to isolate the effectiveness of the target intervention," Clark, who was not involved in the study, told Fox News Digital. Pain is a complex condition influenced by many different factors, according to Clark. "Determining a specific cause of low back pain, particularly when the pain is persistent, is difficult, as the BMJ study points out," he said. "Things like stress, sleep quality, fatigue, fear, social situations, nutrition, sickness and previous history of pain all play a role in how we experience pain." Clark recommends "multimodal" treatments for pain, including multiple interventions tailored to each individual patient's experience. Click Here To Sign Up For Our Health Newsletter "Physical therapy research shows that manual therapy (joint mobilization/manipulation, soft tissue techniques), active interventions like exercise, and education about why you hurt and what to do about it is the ticket," he said. "It's also important to remember that what worked for someone else might not be the exact pathway that works for you." While surgical intervention can be effective for some patients, Clark noted that it can present its own challenges and should be a "last resort" for non-emergency situations. For more Health articles, visit "While surgery is indicated in some cases, it's almost never the answer in isolation," he said. "Understanding pain and the complexity around a person's situation must be in view." "In many cases, conservative care can prevent or delay the need for invasive procedures."Original article source: Just 1 in 10 back pain treatments work, study says — what to do instead
