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Predictors of success of pharmacological management in patients with chronic lower back pain: systematic review

Baroncini, Alice; Maffulli, Nicola; Mian, Michael; Vaishya, Raju; Simeone, Francesco; Migliorini, Filippo

Authors

Alice Baroncini

Nicola Maffulli

Michael Mian

Raju Vaishya

Francesco Simeone

Filippo Migliorini



Abstract

Background: Conservative management is recommended as the first therapeutic step in chronic low back pain (LBP), but there is no available evidence regarding the possible effect of patients’ baseline characteristics on the therapeutic outcomes. A systematic review of the literature was performed to investigate this point. Methods: In February 2024, all the level I studies investigating the role of pharmacological management for chronic LBP were accessed. Data concerning the patient demographic at baseline were collected: number of patients and related mean BMI and age, duration of the symptoms, duration of the follow-up, percentage of females, Numeric Rating Scale (NRS), the Roland Morris Disability Questionnaire (RMQ), Oswestry Disability Index (ODI). The outcomes at the last follow-up were evaluated through NRS, RMQ, and ODI. A multiple linear model regression diagnostic through the Pearson Product-Moment Correlation Coefficient (r) was used. Results: Data from 47 articles (9007 patients) were obtained. The analysis yielded the following significant associations: age at baseline and NRS at follow-up (r = − 0.22; P = 0.04), NRS at baseline with NRS (r = 0.26; P = 0.03) and RMQ (r = − 0.58; P = 0.02) at follow-up, RMQ at baseline and the same at follow-up (r = 0.69; P = 0.0001). Conclusion: Older age, higher BMI, presence of comorbidities, higher ODI and a long history of symptoms or surgical treatments do not reduce the efficacy of pharmacological management of chronic LBP. However, pharmacological therapy is not an effective option for patients with high baseline RMQ. Level of evidence: I systematic review of RCTs.

Journal Article Type Article
Acceptance Date Apr 14, 2024
Online Publication Date Apr 18, 2024
Deposit Date Apr 22, 2024
Publicly Available Date Apr 22, 2024
Journal Journal of Orthopaedic Surgery and Research
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 19
Issue 1
Article Number 248
DOI https://doi.org/10.1186/s13018-024-04741-9
Keywords Pain, Risk factors, Low back pain, Management
Publisher URL https://josr-online.biomedcentral.com/articles/10.1186/s13018-024-04741-9

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Copyright Statement
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.




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