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Bart W Koes - One of the best experts on this subject based on the ideXlab platform.
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nonsteroidal anti inflammatory drugs for Low Back Pain an updated cochrane review
Spine, 2008Co-Authors: Pepijn D D M Roelofs, Bart W Koes, Richard A Deyo, R J P M Scholten, M W Van TulderAbstract:Study Design. A systematic review of randomized controlled trials. Objectives. To assess the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors in the treatment of nonspecific Low Back Pain and to assess which type of NSAID is most effective. Summary of Background Data. NSAIDs are the most frequently prescribed medications worldwide and are widely used for patients with Low Back Pain. Selective COX-2 inhibitors are currently available and used for patients with Low Back Pain. Methods. We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials up to and including June 2007 if reported in English, Dutch, or German. We also screened references given in relevant reviews and identified trials. Randomized trials and double-blind controlled trials of NSAIDs in nonspecific Low Back Pain with or without sciatica were included. Results. In total, 65 trials (total number of patients = 11,237) were included in this review. Twenty-eight trials (42%) were considered high quality. Statistically significant effects were found in favor of NSAIDs compared with placebo, but at the cost of statistically significant more side effects. There is moderate evidence that NSAIDs are not more effective than paracetamol for acute Low Back Pain, but paracetamol had fewer side effects. There is moderate evidence that NSAIDs are not more effective than other drugs for acute Low Back Pain. There is strong evidence that various types of NSAIDs, including COX-2 NSAIDs, are equally effective for acute Low Back Pain. COX-2 NSAIDs had statistically significantly fewer side effects than traditional NSAIDs. Conclusion. The evidence from the 65 trials included in this review suggests that NSAIDs are effective for short-term symptomatic relief in patients with acute and chronic Low Back Pain without sciatica. However, effect sizes are small. Furthermore, there does not seem to be a specific type of NSAID, which is clearly more effective than others. The selective COX-2 inhibitors showed fewer side effects compared with traditional NSAIDs in the randomized controlled trials included in this review. However, recent studies have shown that COX-2 inhibitors are associated with increased cardiovascular risks in specific patient populations.
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non steroidal anti inflammatory drugs for Low Back Pain
Cochrane Database of Systematic Reviews, 2008Co-Authors: Pepijn D D M Roelofs, Bart W Koes, Richard A Deyo, R J P M Scholten, M W Van TulderAbstract:Background Non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequently prescribed medications worldwide and are widely used for patients with Low-Back Pain. Selective COX-2 inhibitors are currently available and used for patients with Low-Back Pain. Objectives The objective was to assess the effects of NSAIDs and COX-2 inhibitors in the treatment of non-specific Low-Back Pain and to assess which type of NSAID is most effective. Search methods We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials up to and including June 2007 if reported in English, Dutch or German. We also screened references given in relevant reviews and identified trials. Selection criteria Randomised trials and double-blind controlled trials of NSAIDs in non-specific Low-Back Pain with or without sciatica were included. Data collection and analysis Two review authors independently extracted data and assessed methodological quality. All studies were also assessed on clinical relevance, from which no further interpretations or conclusions were drawn. If data were considered clinically homogeneous, a meta-analysis was performed. If data were lacking for clinically homogeneous trials, a qualitative analysis was performed using a rating system with four levels of evidence (strong, moderate, limited, no evidence). Main results In total, 65 trials (total number of patients = 11,237) were included in this review. Twenty-eight trials (42%) were considered high quality. Statistically significant effects were found in favour of NSAIDs compared to placebo, but at the cost of statistically significant more side effects. There is moderate evidence that NSAIDs are not more effective than paracetamol for acute Low-Back Pain, but paracetamol had fewer side effects. There is moderate evidence that NSAIDs are not more effective than other drugs for acute Low-Back Pain. There is strong evidence that various types of NSAIDs, including COX-2 NSAIDs, are equally effective for acute Low-Back Pain. COX-2 NSAIDs had statistically significantly fewer side-effects than traditional NSAIDs. Authors' conclusions The evidence from the 65 trials included in this review suggests that NSAIDs are effective for short-term symptomatic relief in patients with acute and chronic Low-Back Pain without sciatica. However, effect sizes are small. Furthermore, there does not seem to be a specific type of NSAID which is clearly more effective than others. The selective COX-2 inhibitors showed fewer side effects compared to traditional NSAIDs in the RCTs included in this review. However, recent studies have shown that COX-2 inhibitors are associated with increased cardiovascular risks in specific patient populations.
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diagnosis and treatment of Low Back Pain
BMJ, 2006Co-Authors: Bart W Koes, Maurits W Van Tulder, Siep ThomasAbstract:Low Back Pain is a considerable health problem in all developed countries and is most commonly treated in primary healthcare settings. It is usually defined as Pain, muscle tension, or stiffness localised beLow the costal margin and above the inferior gluteal folds, with or without leg Pain (sciatica). The most important symptoms of non-specific Low Back Pain are Pain and disability. The diagnostic and therapeutic management of patients with Low Back Pain has long been characterised by considerable variation within and between countries among general practitioners, medical specialists, and other healthcare professionals.1 2 w1 Recently, a large number of randomised clinical trials have been done, systematic reviews have been written, and clinical guidelines have become available. The outlook for evidence based management of Low Back Pain has greatly improved. This review presents the current state of science regarding the diagnosis and treatment of Low Back Pain. We used the Cochrane Library to identify relevant systematic reviews that evaluate the effectiveness of conservative, complementary, and surgical interventions. Medline searches were used to find other relevant systematic reviews on diagnosis and treatment of Low Back Pain, with the keywords “Low Back Pain”, “systematic review”, “meta-analysis”, “diagnosis”, and “treatment”. Our personal files were used for additional references. We also checked available clinical guidelines and used Clinical Evidence as source for clinically relevant information on benefits and harms of treatments.3 4 Most of us will experience at least one episode of Low Back Pain during our life. Reported lifetime prevalence varies from 49% to 70% and point prevalences from 12% to 30% are reported in Western countries.w2 w3 The diagnostic process is mainly focused on the triage of patients with specific or non-specific Low Back Pain. Specific Low Back Pain is defined as symptoms caused by a specific pathophysiological mechanism, such …
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exercise therapy for treatment of non specific Low Back Pain
Cochrane Database of Systematic Reviews, 2005Co-Authors: Jill A Hayden, Antti Malmivaara, M W Van Tulder, Bart W KoesAbstract:Background Exercise therapy is widely used as an intervention in Low-Back Pain. Objectives To evaluate the effectiveness of exercise therapy in adult non-specific acute, subacute and chronic Low-Back Pain versus no treatment and other conservative treatments. Search methods The Cochrane Central Register of Controlled Trials (Issue 3, 2004), MEDLINE, EMBASE, PsychInfo, CINAHL databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews. Selection criteria Randomized controlled trials evaluating exercise therapy for adult non-specific Low-Back Pain and measuring Pain, function, return-to-work/absenteeism, and/or global improvement outcomes. Data collection and analysis Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short, intermediate, and long-term folLow-up. Main results Sixty-one randomized controlled trials (6390 participants) met inclusion criteria: acute (11), subacute (6) and chronic (43) Low-Back Pain (1 unclear). Evidence was found of effectiveness in chronic populations relative to comparisons at all folLow-up periods; pooled mean improvement was 7.3 points (95% CI, 3.7 to 10.9) for Pain (out of 100), 2.5 points (1.0 to 3.9) for function (out of 100) at earliest folLow-up. In studies investigating patients (i.e. presenting to healthcare providers) mean improvement was 13.3 points (5.5 to 21.1) for Pain, 6.9 (2.2 to 11.7) for function, representing significantly greater improvement over studies where participants included those recruited from a general population (e.g. with advertisements). There is some evidence of effectiveness of graded-activity exercise program in subacute Low-Back Pain in occupational settings, though the evidence for other types of exercise therapy in other populations is inconsistent. There was evidence of equal effectiveness relative to comparisons in acute populations [Pain: 0.03 points (95% CI, -1.3 to 1.4)]. Limitations: This review largely reflects limitations of the literature, including Low quality studies with heterogeneous outcome measures, inconsistent and poor reporting, and possibility of publication bias. Authors' conclusions Exercise therapy appears to be slightly effective at decreasing Pain and improving function in adults with chronic Low-Back Pain, particularly in healthcare populations. In subacute Low-Back Pain there is some evidence that a graded activity program improves absenteeism outcomes, though evidence for other types of exercise is unclear. In acute Low-Back Pain, exercise therapy is as effective as either no treatment or other conservative treatments.
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meta analysis exercise therapy for nonspecific Low Back Pain
Annals of Internal Medicine, 2005Co-Authors: Jill A Hayden, Maurits W Van Tulder, Antti Malmivaara, Bart W KoesAbstract:This meta-analysis found that exercise therapy has a small beneficial effect on Pain and function in adults with chronic Low Back Pain. In subacute Low Back Pain, some evidence suggests that a grad...
Rachelle Buchbinder - One of the best experts on this subject based on the ideXlab platform.
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Low Back Pain a call for action
The Lancet, 2018Co-Authors: Rachelle Buchbinder, Anthony D Woolf, Maurits W Van Tulder, Peter Croft, Birgitta Oberg, Luciola Da Cunha Menezes Costa, Mark L Schoene, Jan Hartvigsen, Dan Cherkin, Nadine E FosterAbstract:Low Back Pain is the leading worldwide cause of years lost to disability and its burden is growing alongside the increasing and ageing population.1 Because these population shifts are more rapid in Low-income and middle-income countries, where adequate resources to address the problem might not exist, the effects will probably be more extreme in these regions. Most Low Back Pain is unrelated to specific identifiable spinal abnormalities, and our Viewpoint, the third paper in this Lancet Series,2,3 is a call for action on this global problem of Low Back Pain.
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non specific Low Back Pain
The Lancet, 2017Co-Authors: Christopher G Maher, Martin Underwood, Rachelle BuchbinderAbstract:Summary Non-specific Low Back Pain affects people of all ages and is a leading contributor to disease burden worldwide. Management guidelines endorse triage to identify the rare cases of Low Back Pain that are caused by medically serious pathology, and so require diagnostic work-up or specialist referral, or both. Because non-specific Low Back Pain does not have a known pathoanatomical cause, treatment focuses on reducing Pain and its consequences. Management consists of education and reassurance, analgesic medicines, non-pharmacological therapies, and timely review. The clinical course of Low Back Pain is often favourable, thus many patients require little if any formal medical care. Two treatment strategies are currently used, a stepped approach beginning with more simple care that is progressed if the patient does not respond, and the use of simple risk prediction methods to individualise the amount and type of care provided. The overuse of imaging, opioids, and surgery remains a widespread problem.
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placing the global burden of Low Back Pain in context
Best Practice & Research: Clinical Rheumatology, 2013Co-Authors: Rachelle Buchbinder, Anthony D Woolf, Lyn March, P M Brooks, Fiona M Blyth, Damian G HoyAbstract:The latest Global Burden of Disease Study, published at the end of 2012, has highlighted the enormous global burden of Low Back Pain. In contrast to the previous study, when it was ranked 105 out of 136 conditions, Low Back Pain is now the leading cause of disability globally, ahead of 290 other conditions. It was estimated to be responsible for 58.2 million years lived with disability in 1990, increasing to 83 million in 2010. This chapter illustrates the ways that the Global Burden of Disease data can be displayed using the data visualisation tools specifically designed for this purpose. It also considers how best to increase the precision of future global burden of Low Back Pain estimates by identifying limitations in the available data and priorities for further research. Finally, it discusses what should be done at a policy level to militate against the rising burden of this condition.
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a systematic review of the global prevalence of Low Back Pain
Arthritis & Rheumatism, 2012Co-Authors: Damian Hoy, Anthony D Woolf, Lyn March, P M Brooks, Chris Bain, Gail M. Williams, Fiona M Blyth, Theo Vos, Rachelle BuchbinderAbstract:Objective To perform a systematic review of the global prevalence of Low Back Pain, and to examine the influence that case definition, prevalence period, and other variables have on prevalence. Methods We conduced a new systematic review of the global prevalence of Low Back Pain that included general population studies published between 1980 and 2009. A total of 165 studies from 54 countries were identified. Of these, 64% had been published since the last comparable review. Results Low Back Pain was shown to be a major problem throughout the world, with the highest prevalence among female individuals and those aged 40–80 years. After adjusting for methodologic variation, the mean ± SEM point prevalence was estimated to be 11.9 ± 2.0%, and the 1-month prevalence was estimated to be 23.2 ± 2.9%. Conclusion As the population ages, the global number of individuals with Low Back Pain is likely to increase substantially over the coming decades. Investigators are encouraged to adopt recent recommendations for a standard definition of Low Back Pain and to consult a recently developed tool for assessing the risk of bias of prevalence studies.
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the epidemiology of Low Back Pain
Best Practice & Research: Clinical Rheumatology, 2010Co-Authors: Damian G Hoy, P M Brooks, Fiona M Blyth, Rachelle BuchbinderAbstract:Low Back Pain is an extremely common problem that most people experience at some point in their life. While substantial heterogeneity exists among Low Back Pain epidemiological studies limiting the ability to compare and pool data, estimates of the 1 year incidence of a first-ever episode of Low Back Pain range between 6.3% and 15.4%, while estimates of the 1 year incidence of any episode of Low Back Pain range between 1.5% and 36%. In health facility- or clinic-based studies, episode remission at 1 year ranges from 54% to 90%; however, most studies do not indicate whether the episode was continuous between the baseline and folLow-up time point(s). Most people who experience activity-limiting Low Back Pain go on to have recurrent episodes. Estimates of recurrence at 1 year range from 24% to 80%. Given the variation in definitions of remission and recurrence, further population-based research is needed to assess the daily patterns of Low Back Pain episodes over 1 year and longer. There is substantial information on Low Back Pain prevalence and estimates of the point prevalence range from 1.0% to 58.1% (mean: 18.1%; median: 15.0%), and 1 year prevalence from 0.8% to 82.5% (mean: 38.1%; median: 37.4%). Due to the heterogeneity of the data, mean estimates need to be interpreted with caution. Many environmental and personal factors influence the onset and course of Low Back Pain. Studies have found the incidence of Low Back Pain is highest in the third decade, and overall prevalence increases with age until the 60-65 year age group and then gradually declines. Other commonly reported risk factors include Low educational status, stress, anxiety, depression, job dissatisfaction, Low levels of social support in the workplace and whole-body vibration. Low Back Pain has an enormous impact on individuals, families, communities, governments and businesses throughout the world. The Global Burden of Disease 2005 Study (GBD 2005) is currently making estimates of the global burden of Low Back Pain in relation to impairment and activity limitation. Results will be available in 2011. Further research is needed to help us understand more about the broader outcomes and impacts from Low Back Pain.
L M Bouter - One of the best experts on this subject based on the ideXlab platform.
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muscle relaxants for non specific Low Back Pain
Cochrane Database of Systematic Reviews, 2003Co-Authors: Maurits W Van Tulder, Andrea D Furlan, Tony Touray, Sherra Solway, L M BouterAbstract:Background The use of muscle relaxants in the management of non-specific Low Back Pain is controversial. It is not clear if they are effective, and concerns have been raised about the potential adverse effects involved. Objectives The aim of this review was to determine if muscle relaxants are effective in the treatment of non-specific Low Back Pain. Search methods A computer-assisted search of the Cochrane Library (Issue 3, 2002), MEDLINE (1966 up to October 2002) and EMBASE (1988 up to October 2002) was carried out. These databases were searched using the algorithm recommended by the Cochrane Back Review Group. References cited in the identified articles and other relevant literature were screened. Selection criteria Randomised and/or double-blinded controlled trials, involving patients diagnosed with non-specific Low Back Pain, treated with muscle relaxants as monotherapy or in combination with other therapeutic modalities, were included for review. Data collection and analysis Two authors independently carried out the methodological quality assessment and data extraction of the trials. The analysis comprised not only a quantitative analysis (statistical pooling) but also a qualitative analysis ("best evidence synthesis"). This involved the appraisal of the strength of evidence for various conclusions using a rating system based on the quality and outcomes of the studies included. Evidence was classified as "strong", "moderate", "limited", "conflicting" or "no" evidence. Main results Thirty trials met the inclusion criteria. Twenty-three trials (77%) were of high quality, 24 trials (80%) were on acute Low Back Pain. Four trials studied benzodiazepines, 11 non-benzodiazepines and two antispasticity muscle relaxants in comparison with placebo. Results showed that there is strong evidence that any of these muscle relaxants are more effective than placebo for patients with acute LBP on short-term Pain relief. The pooled RR for non-benzodiazepines versus placebo after two to four days was 0.80 [95% CI; 0.71 to 0.89] for Pain relief and 0.49 [95% CI; 0.25 to 0.95] for global efficacy. Adverse events, however, with a relative risk of 1.50 [95% CI; 1.14 to 1.98] were significantly more prevalent in patients receiving muscle relaxants and especially the central nervous system adverse effects (RR 2.04; 95% CI; 1.23 to 3.37). The various muscle relaxants were found to be similar in performance. Authors' conclusions Muscle relaxants are effective in the management of non-specific Low Back Pain, but the adverse effects require that they be used with caution. Trials are needed that evaluate if muscle relaxants are more effective than analgesics or non-steroidal anti-inflammatory drugs.
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episodes of Low Back Pain a proposal for uniform definitions to be used in research
Spine, 2002Co-Authors: Henrica C W De Vet, L M Bouter, Kate M Dunn, Gary J Macfarlane, Martijn W Heymans, Daniel Pope, Allard J Van Der Beek, Peter CroftAbstract:Study Design. Literature review and group discussions. Objective. To propose uniform definitions for Low Back Pain episodes to be used in research. Background. Different definitions of episodes have been used in Low Back Pain studies. This hampers comparison of study results. Definitions are proposed for episodes of Low Back Pain, care for Low Back Pain, and work absence because of Low Back Pain. Methods. In a Medline search, we identified about 1200 papers, of which 81 possibly contained a definition of episodes. In group discussions, we decided which definitions to propose and discussed their applicability. Results. We found few definitions in the literature. In the group discussions we decided to define an episode of LBP as a period of Pain in the Lower Back lasting for more than 24 hours, preceded and folLowed by a period of at least 1 month without Low Back Pain. An episode of care for Low Back Pain was defined as a consultation or a series of consultations for Low Back Pain, preceded and folLowed by at least 3 months without consultation for Low Back Pain. An episode of work absence due to Low Back Pain was defined as a period of work absence due to Low Back Pain, preceded and folLowed by a period of at least 1 day at work. Conclusions. In many studies, episodes of Low Back Pain are mentioned without a clear definition. We consider our proposed definitions of episodes to be arbitrary but well considered. We advise that they be tested for use in future research.
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psychosocial work characteristics and psychological strain in relation to Low Back Pain
Scandinavian Journal of Work Environment & Health, 2001Co-Authors: W E Hoogendoorn, P M Bongers, I L D Houtman, G A M Ariens, W Van Mechelen, L M BouterAbstract:Objectives This study investigated the relationship between psychosocial work characteristics and Low-Back Pain and the potential intermediate role of psychological strain variables in this relationship. Methods The research was part of a prospective cohort study of risk factors for musculoskeletal symptoms. The study population consisted of 861 workers from 34 companies in The Netherlands who had no Low-Back Pain at baseline and for whom data on the occurrence of Low-Back Pain were obtained with annual questionnaires during a 3-year folLow-up period. Information on psychosocial work characteristics and psychological strain variables was collected using a questionnaire at baseline. Cases of Low-Back Pain were defined as workers who reported, in at least one of the annual folLow-up questionnaires, that they had had regular or prolonged Low-Back Pain in the previous 12 months. Results After adjustment for individual factors and quantified physical load at work, nonsignificant relative risks ranging from 1.3 to 1.6 were observed for high quantitative job demands, high conflicting demands, Low supervisory support, and Low co-worker support. Decision authority and skill discretion showed no relationship with Low-Back Pain. In general, the estimated relative risks for the psychosocial work characteristics were scarcely influenced by additional adjustment for job satisfaction, emotional exhaustion, and sleeping difficulties. Conclusions It can be concluded that Low social support, from either supervisors or co-workers, appears to be a risk factor for Low-Back Pain. Some indications of a relationship between high quantitative job demands and high conflicting demands and Low-Back Pain were also found. Little evidence was found for an intermediate role for the psychological strain variables under study.
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spinal radiographic findings and nonspecific Low Back Pain a systematic review of observational studies
Spine, 1997Co-Authors: M W Van Tulder, Bart W Koes, W J J Assendelft, L M BouterAbstract:STUDY DESIGN: A systematic review of published observational studies. OBJECTIVES: To examine the causal relationship between radiographic findings and nonspecific Low Back Pain. SUMMARY OF BackGROUND DATA: The causal relationship between radiographic findings and nonspecific Low Back Pain still is controversial. METHODS: Two reviewers independently scored the methodologic quality of all relevant, available studies using a standardized set of criteria. The association between radiographic findings and nonspecific Low Back Pain was expressed as an odds ratio with a corresponding 95% confidence interval. RESULTS: Degeneration, defined by the presence of disc space narrowing, osteophytes, and sclerosis, turned out to be associated with nonspecific Low Back Pain with odds ratios ranging from 1.2 to 3.3. Spondylolysis and spondylolisthesis, spina bifida, transitional vertebrae, spondylosis, and Scheuermann's disease did not appear to be associated with Low Back Pain. The validity scores of the observational studies ranged from 0% to 91% of the maximum score. Only two studies used a prospective design, and most studies lacked control for confounding, an appropriate test for nonspecific Low Back Pain, and blinded assessment of radiographs and Low Back Pain status. CONCLUSIONS: There is no firm evidence for the presence or absence of a causal relationship between radiographic findings and nonspecific Low Back Pain.
Maurits W Van Tulder - One of the best experts on this subject based on the ideXlab platform.
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Low Back Pain a call for action
The Lancet, 2018Co-Authors: Rachelle Buchbinder, Anthony D Woolf, Maurits W Van Tulder, Peter Croft, Birgitta Oberg, Luciola Da Cunha Menezes Costa, Mark L Schoene, Jan Hartvigsen, Dan Cherkin, Nadine E FosterAbstract:Low Back Pain is the leading worldwide cause of years lost to disability and its burden is growing alongside the increasing and ageing population.1 Because these population shifts are more rapid in Low-income and middle-income countries, where adequate resources to address the problem might not exist, the effects will probably be more extreme in these regions. Most Low Back Pain is unrelated to specific identifiable spinal abnormalities, and our Viewpoint, the third paper in this Lancet Series,2,3 is a call for action on this global problem of Low Back Pain.
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diagnosis and treatment of Low Back Pain
BMJ, 2006Co-Authors: Bart W Koes, Maurits W Van Tulder, Siep ThomasAbstract:Low Back Pain is a considerable health problem in all developed countries and is most commonly treated in primary healthcare settings. It is usually defined as Pain, muscle tension, or stiffness localised beLow the costal margin and above the inferior gluteal folds, with or without leg Pain (sciatica). The most important symptoms of non-specific Low Back Pain are Pain and disability. The diagnostic and therapeutic management of patients with Low Back Pain has long been characterised by considerable variation within and between countries among general practitioners, medical specialists, and other healthcare professionals.1 2 w1 Recently, a large number of randomised clinical trials have been done, systematic reviews have been written, and clinical guidelines have become available. The outlook for evidence based management of Low Back Pain has greatly improved. This review presents the current state of science regarding the diagnosis and treatment of Low Back Pain. We used the Cochrane Library to identify relevant systematic reviews that evaluate the effectiveness of conservative, complementary, and surgical interventions. Medline searches were used to find other relevant systematic reviews on diagnosis and treatment of Low Back Pain, with the keywords “Low Back Pain”, “systematic review”, “meta-analysis”, “diagnosis”, and “treatment”. Our personal files were used for additional references. We also checked available clinical guidelines and used Clinical Evidence as source for clinically relevant information on benefits and harms of treatments.3 4 Most of us will experience at least one episode of Low Back Pain during our life. Reported lifetime prevalence varies from 49% to 70% and point prevalences from 12% to 30% are reported in Western countries.w2 w3 The diagnostic process is mainly focused on the triage of patients with specific or non-specific Low Back Pain. Specific Low Back Pain is defined as symptoms caused by a specific pathophysiological mechanism, such …
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meta analysis exercise therapy for nonspecific Low Back Pain
Annals of Internal Medicine, 2005Co-Authors: Jill A Hayden, Maurits W Van Tulder, Antti Malmivaara, Bart W KoesAbstract:This meta-analysis found that exercise therapy has a small beneficial effect on Pain and function in adults with chronic Low Back Pain. In subacute Low Back Pain, some evidence suggests that a grad...
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muscle relaxants for non specific Low Back Pain
Cochrane Database of Systematic Reviews, 2003Co-Authors: Maurits W Van Tulder, Andrea D Furlan, Tony Touray, Sherra Solway, L M BouterAbstract:Background The use of muscle relaxants in the management of non-specific Low Back Pain is controversial. It is not clear if they are effective, and concerns have been raised about the potential adverse effects involved. Objectives The aim of this review was to determine if muscle relaxants are effective in the treatment of non-specific Low Back Pain. Search methods A computer-assisted search of the Cochrane Library (Issue 3, 2002), MEDLINE (1966 up to October 2002) and EMBASE (1988 up to October 2002) was carried out. These databases were searched using the algorithm recommended by the Cochrane Back Review Group. References cited in the identified articles and other relevant literature were screened. Selection criteria Randomised and/or double-blinded controlled trials, involving patients diagnosed with non-specific Low Back Pain, treated with muscle relaxants as monotherapy or in combination with other therapeutic modalities, were included for review. Data collection and analysis Two authors independently carried out the methodological quality assessment and data extraction of the trials. The analysis comprised not only a quantitative analysis (statistical pooling) but also a qualitative analysis ("best evidence synthesis"). This involved the appraisal of the strength of evidence for various conclusions using a rating system based on the quality and outcomes of the studies included. Evidence was classified as "strong", "moderate", "limited", "conflicting" or "no" evidence. Main results Thirty trials met the inclusion criteria. Twenty-three trials (77%) were of high quality, 24 trials (80%) were on acute Low Back Pain. Four trials studied benzodiazepines, 11 non-benzodiazepines and two antispasticity muscle relaxants in comparison with placebo. Results showed that there is strong evidence that any of these muscle relaxants are more effective than placebo for patients with acute LBP on short-term Pain relief. The pooled RR for non-benzodiazepines versus placebo after two to four days was 0.80 [95% CI; 0.71 to 0.89] for Pain relief and 0.49 [95% CI; 0.25 to 0.95] for global efficacy. Adverse events, however, with a relative risk of 1.50 [95% CI; 1.14 to 1.98] were significantly more prevalent in patients receiving muscle relaxants and especially the central nervous system adverse effects (RR 2.04; 95% CI; 1.23 to 3.37). The various muscle relaxants were found to be similar in performance. Authors' conclusions Muscle relaxants are effective in the management of non-specific Low Back Pain, but the adverse effects require that they be used with caution. Trials are needed that evaluate if muscle relaxants are more effective than analgesics or non-steroidal anti-inflammatory drugs.
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exercise therapy for Low Back Pain
Cochrane Database of Systematic Reviews, 2000Co-Authors: Maurits W Van Tulder, Antti Malmivaara, Rosmin Esmail, Bart W KoesAbstract:Background Exercise therapy is a widely used treatment for Low Back Pain. Objectives The objective of this review was to assess the effectiveness of exercise therapy for Low Back Pain with regard to Pain intensity, functional status, overall improvement and return to work. Search strategy We searched the Cochrane Controlled Trials Register (1999, issue 1), MEDLINE (1966 - April 1999), EMBASE (1988 - September 1998), PsycLIT (from 1984 to April 1999) and reference lists of articles. Selection criteria Randomised trials of all types of exercise therapy for subjects with non-specific Low Back Pain with or without radiation into the legs. Data collection and analysis Two reviewers independently extracted data and assessed trial quality. Because trials were considered heterogeneous with regard to study populations, interventions and outcomes, we decided not to perform a meta-analysis but to summarise the results using a rating system of four levels of evidence (strong, moderate, limited or no evidence). Main results 39 RCTs were identified. There is strong evidence that exercise therapy is not more effective than inactive or other active treatments it has been compared with for acute Low Back Pain. There is conflicting evidence on the effectiveness of exercise therapy compared with inactive treatments for chronic Low Back Pain. Exercise therapy was more effective than usual care by the general practitioner and equally effective as conventional physiotherapy for chronic Low Back Pain. Reviewer's conclusions The evidence summarised in this systematic review does not indicate that specific exercises are effective for the treatment of acute Low Back Pain. Exercises may be helpful for chronic Low Back Pain patients to increase return to normal daily activities and work.
M W Van Tulder - One of the best experts on this subject based on the ideXlab platform.
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nonsteroidal anti inflammatory drugs for Low Back Pain an updated cochrane review
Spine, 2008Co-Authors: Pepijn D D M Roelofs, Bart W Koes, Richard A Deyo, R J P M Scholten, M W Van TulderAbstract:Study Design. A systematic review of randomized controlled trials. Objectives. To assess the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors in the treatment of nonspecific Low Back Pain and to assess which type of NSAID is most effective. Summary of Background Data. NSAIDs are the most frequently prescribed medications worldwide and are widely used for patients with Low Back Pain. Selective COX-2 inhibitors are currently available and used for patients with Low Back Pain. Methods. We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials up to and including June 2007 if reported in English, Dutch, or German. We also screened references given in relevant reviews and identified trials. Randomized trials and double-blind controlled trials of NSAIDs in nonspecific Low Back Pain with or without sciatica were included. Results. In total, 65 trials (total number of patients = 11,237) were included in this review. Twenty-eight trials (42%) were considered high quality. Statistically significant effects were found in favor of NSAIDs compared with placebo, but at the cost of statistically significant more side effects. There is moderate evidence that NSAIDs are not more effective than paracetamol for acute Low Back Pain, but paracetamol had fewer side effects. There is moderate evidence that NSAIDs are not more effective than other drugs for acute Low Back Pain. There is strong evidence that various types of NSAIDs, including COX-2 NSAIDs, are equally effective for acute Low Back Pain. COX-2 NSAIDs had statistically significantly fewer side effects than traditional NSAIDs. Conclusion. The evidence from the 65 trials included in this review suggests that NSAIDs are effective for short-term symptomatic relief in patients with acute and chronic Low Back Pain without sciatica. However, effect sizes are small. Furthermore, there does not seem to be a specific type of NSAID, which is clearly more effective than others. The selective COX-2 inhibitors showed fewer side effects compared with traditional NSAIDs in the randomized controlled trials included in this review. However, recent studies have shown that COX-2 inhibitors are associated with increased cardiovascular risks in specific patient populations.
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non steroidal anti inflammatory drugs for Low Back Pain
Cochrane Database of Systematic Reviews, 2008Co-Authors: Pepijn D D M Roelofs, Bart W Koes, Richard A Deyo, R J P M Scholten, M W Van TulderAbstract:Background Non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequently prescribed medications worldwide and are widely used for patients with Low-Back Pain. Selective COX-2 inhibitors are currently available and used for patients with Low-Back Pain. Objectives The objective was to assess the effects of NSAIDs and COX-2 inhibitors in the treatment of non-specific Low-Back Pain and to assess which type of NSAID is most effective. Search methods We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials up to and including June 2007 if reported in English, Dutch or German. We also screened references given in relevant reviews and identified trials. Selection criteria Randomised trials and double-blind controlled trials of NSAIDs in non-specific Low-Back Pain with or without sciatica were included. Data collection and analysis Two review authors independently extracted data and assessed methodological quality. All studies were also assessed on clinical relevance, from which no further interpretations or conclusions were drawn. If data were considered clinically homogeneous, a meta-analysis was performed. If data were lacking for clinically homogeneous trials, a qualitative analysis was performed using a rating system with four levels of evidence (strong, moderate, limited, no evidence). Main results In total, 65 trials (total number of patients = 11,237) were included in this review. Twenty-eight trials (42%) were considered high quality. Statistically significant effects were found in favour of NSAIDs compared to placebo, but at the cost of statistically significant more side effects. There is moderate evidence that NSAIDs are not more effective than paracetamol for acute Low-Back Pain, but paracetamol had fewer side effects. There is moderate evidence that NSAIDs are not more effective than other drugs for acute Low-Back Pain. There is strong evidence that various types of NSAIDs, including COX-2 NSAIDs, are equally effective for acute Low-Back Pain. COX-2 NSAIDs had statistically significantly fewer side-effects than traditional NSAIDs. Authors' conclusions The evidence from the 65 trials included in this review suggests that NSAIDs are effective for short-term symptomatic relief in patients with acute and chronic Low-Back Pain without sciatica. However, effect sizes are small. Furthermore, there does not seem to be a specific type of NSAID which is clearly more effective than others. The selective COX-2 inhibitors showed fewer side effects compared to traditional NSAIDs in the RCTs included in this review. However, recent studies have shown that COX-2 inhibitors are associated with increased cardiovascular risks in specific patient populations.
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spinal radiographic findings and nonspecific Low Back Pain a systematic review of observational studies
Spine, 1997Co-Authors: M W Van Tulder, Bart W Koes, W J J Assendelft, L M BouterAbstract:STUDY DESIGN: A systematic review of published observational studies. OBJECTIVES: To examine the causal relationship between radiographic findings and nonspecific Low Back Pain. SUMMARY OF BackGROUND DATA: The causal relationship between radiographic findings and nonspecific Low Back Pain still is controversial. METHODS: Two reviewers independently scored the methodologic quality of all relevant, available studies using a standardized set of criteria. The association between radiographic findings and nonspecific Low Back Pain was expressed as an odds ratio with a corresponding 95% confidence interval. RESULTS: Degeneration, defined by the presence of disc space narrowing, osteophytes, and sclerosis, turned out to be associated with nonspecific Low Back Pain with odds ratios ranging from 1.2 to 3.3. Spondylolysis and spondylolisthesis, spina bifida, transitional vertebrae, spondylosis, and Scheuermann's disease did not appear to be associated with Low Back Pain. The validity scores of the observational studies ranged from 0% to 91% of the maximum score. Only two studies used a prospective design, and most studies lacked control for confounding, an appropriate test for nonspecific Low Back Pain, and blinded assessment of radiographs and Low Back Pain status. CONCLUSIONS: There is no firm evidence for the presence or absence of a causal relationship between radiographic findings and nonspecific Low Back Pain.
