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Medscape
2 days ago
- Health
- Medscape
Nonsurgical Options Show Modest Benefit in Chronic Back Pain
In people with nonspecific chronic low back pain, nonsurgical interventions like cognitive-behavioral therapy and mindfulness possibly showed small-to-moderate long-term benefits in reducing pain intensity and disability. However, the evidence was mostly of low-to-moderate certainty. METHODOLOGY: Researchers conducted a systematic review and meta-analysis of 75 randomized or cluster randomized controlled trials involving 15,395 participants aged 16 years or older (mean age, 45.7 years; median percentage of women, 61%) with chronic low back pain lasting at least 12 weeks. They assessed the effectiveness of nonsurgical interventions for chronic low back pain (including 91% trials on nonspecific chronic low back pain) with a focus on long-term (1-2 years) and very long-term (≥ 2 years) outcomes. Psychological, physical, and combination nonsurgical interventions, including cognitive-behavioral therapy, mindfulness, and multidisciplinary care, were assessed, with exercise being the most frequently assessed intervention. Interventions were compared with placebo or sham, adjuvant interventions, no intervention, or usual care. Pain intensity and disability were assessed using scales like the Numerical Pain Rating Scale and Oswestry Disability Index, respectively, along with other measures, and the certainty of evidence was assessed. TAKEAWAY: At long-term follow-up, small-to-moderate reductions in pain intensity and disability were possibly seen with cognitive-behavioral therapy (mean differences, -7.2 and -5.7, respectively) and mindfulness (mean differences, -10.0 and -9.3, respectively) in individuals with nonspecific chronic low back pain. The evidence was of moderate certainty. Goal setting and needling interventions probably resulted in small reductions in disability, with mean differences of -8.3 and -4.8, respectively. Multicomponent biopsychosocial care and behavioral therapy might have led to moderate and small reductions, respectively, in pain intensity in those with nonspecific chronic low back pain (mean differences, -10.2 and -7.4, respectively; low-certainty evidence). Multidisciplinary care could have led to small reductions in disability (mean difference, -8.3). At very long-term follow-up, multidisciplinary care may have led to a moderate reduction in pain intensity (mean difference, -10.1), whereas exercise may have resulted in a moderate decrease in disability (mean difference, -10.2) in those with nonspecific chronic low back pain. The evidence was mostly of low certainty. IN PRACTICE: 'Although we identified some interventions with long-term effects for people with chronic low back pain, the clinical importance of the effects is uncertain,' the study authors wrote. 'Greater attention is needed on developing and testing interventions with long-term effects for chronic low back pain.' SOURCE: The study was led by Hazel J. Jenkins, PhD, Macquarie University, Sydney, Australia. It was published online on May 28, 2025, in The Lancet Rheumatology . LIMITATIONS: The certainty of the evidence was reduced for most comparisons because of the quality of the studies and inconsistencies in the results. DISCLOSURES: The study reported receiving no specific funding. Some authors reported receiving grants, support for attending meetings, research fellowships, and serving as members of the executive board of the network and/or as members of associations outside the submitted work.
Medscape
05-06-2025
- Health
- Medscape
Continuing Metformin Reduces PCOS Pregnancy Risks
Continuing metformin throughout the first trimester in women with polycystic ovary syndrome (PCOS) showed the potential to reduce miscarriage risk (odds ratio [OR], 0.64) and increase clinical pregnancy rates (OR, 1.57) compared with placebo. A meta-analysis of 12 randomized controlled trials involving 1708 women suggested that stopping metformin at pregnancy confirmation might be less beneficial than continuation through the first trimester. METHODOLOGY: Researchers conducted a systematic review and meta-analysis of randomized controlled trials evaluating metformin started preconception and continued at least until positive pregnancy test compared with placebo or no treatment in women with PCOS. The analysis included 12 trustworthy studies with 1708 participants, with trials conducted across 14 countries spanning five continents, all graded as low to moderate quality evidence. The primary outcome measure focused on miscarriage rate, defined as pregnancy loss prior to 20 completed weeks of gestation, while secondary outcomes included clinical pregnancy and live birth rates. Investigators performed indirect comparisons between treatment groups using the Bucher technique to evaluate clinical pregnancy, miscarriage, and live birth rates for metformin treatment continued throughout first trimester vs stopped at a positive pregnancy test. TAKEAWAY: Women receiving preconception metformin continued throughout the first trimester had higher clinical pregnancy rates (OR, 1.57; 95% CI, 1.11-2.23), potential reduction in miscarriage (OR, 0.64; 95% CI, 0.32-1.25), and possible increase in live birth (OR, 1.24; 95% CI, 0.59-2.61) compared with placebo or no treatment. Participants who stopped metformin once pregnant showed an increased clinical pregnancy rate (OR, 1.35; 95% CI, 1.01-1.80) but suggested higher miscarriage risk (OR, 1.46; 95% CI, 0.73-2.90) compared with placebo or no treatment. Indirect comparisons consistently favored continuing metformin through first trimester vs stopping at pregnancy confirmation for clinical pregnancy (OR, 1.16; 95% CI, 0.74-1.83), miscarriage (OR, 0.44; 95% CI, 0.17-1.16), and live birth (OR, 1.14; 95% CI, 0.41-3.13). IN PRACTICE: 'Women with PCOS have been shown to have a fivefold increased risk per year of developing insulin resistance and subsequent type 2 diabetes. Insulin resistance has been shown to be independently associated with a higher risk of miscarriage. Metformin acts by decreasing gluconeogenesis, lipogenesis and enhancing glucose uptake, all of which in turn reduce insulin resistance,' wrote the authors of the study. SOURCE: The study was led by James Cheshire, PhD, Birmingham Women's and Children's NHS Foundation Trust in Birmingham, England. It was published online in American Journal of Obstetrics and Gynecology . LIMITATIONS: According to the authors, the main limitation was the inherent heterogeneous nature of the study population and the overall low quality of evidence. Women with PCOS have different phenotypes and varying degrees of hyperandrogenism and insulin resistance, which could not be accounted for in the analyses. Additionally, many studies did not subdivide pregnancy outcome data by body mass index (BMI), preventing meaningful analyses in BMI subgroups. The limited outcome data in spontaneously conceiving populations (only 30 women from two studies) make it difficult to extrapolate findings to this group. DISCLOSURES: The authors reported having no conflicts of interest. The study received no external funding.
Medscape
19-05-2025
- Health
- Medscape
DASH Diet Tied to Lower Risk for Colorectal Cancer
Adherence to the dietary approaches to stop hypertension (DASH) diet — which emphasizes fruits, vegetables, lean proteins, whole grains, nuts, and low-fat dairy — was associated with a 19% reduced risk for colorectal cancer (CRC), with stronger protective effects observed in men than in women. METHODOLOGY: Conflicting evidence exists on the link between adherence to the DASH diet and CRC risk, highlighting the need for a comprehensive analysis. Researchers performed a systematic review and meta-analysis of observational studies analyzing the association between adherence to the DASH diet and CRC risk. Effect sizes were reported as hazard ratios, odds ratios, or relative risks (RRs) in the included studies, with most studies analyzing outcomes in both men and women. The methodological quality of the studies was independently assessed using relevant parameters. TAKEAWAY: Researchers included 14 studies: Eight cohort studies, four case-control studies, one cross-sectional study, and one comparative analysis; all studies had a low to moderate risk for bias and moderate to high quality. DASH adherence was associated with a significantly reduced risk for CRC (RR, 0.81), as analyzed in 13 effect sizes from nine articles. Risk reduction was greater in men (RR, 0.77) than in women (RR, 0.84). DASH adherence was associated with a 25% reduced risk for rectal cancer and a 17% reduced risk for colon cancer, according to an analysis of six and five effect sizes, respectively. Analysis of four effect sizes showed a substantially reduced risk for colorectal adenoma following adherence to the DASH diet (RR, 0.42). IN PRACTICE: 'The DASH diet can be a valuable component of a personalized plan for many in high-risk groups, but it shouldn't be presented as a one-size-fits-all solution,' the authors wrote. 'Registered dietitians and healthcare professionals play a crucial role in creating tailored dietary plans that are both effective and achievable for each individual,' they added. SOURCE: Mohammad Mehdi Abbasi of Shahid Beheshti University of Medical Sciences in Tehran, Paria Babaahmadi of Shiraz University of Medical Sciences in Shiraz, and Fateme Nozari of Tehran University of Medical Sciences in Tehran, all in Iran, led the study. It was published online in BMC Gastroenterology . LIMITATIONS: Included studies used different methods to assess DASH adherence, and its application varied across cultures and populations. Differences in various cooking styles, such as grilling, which might induce carcinogenesis, were not addressed. Colon and rectal adenomas were not specifically addressed in the included studies. DISCLOSURES: This study received no financial support. The authors declared having no competing interests.
