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

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.

Citation

Baroncini, A., Maffulli, N., Mian, M., Vaishya, R., Simeone, F., & Migliorini, F. (in press). Predictors of success of pharmacological management in patients with chronic lower back pain: systematic review. Journal of Orthopaedic Surgery and Research, 19(1), Article 248. https://doi.org/10.1186/s13018-024-04741-9

• 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
• Public URL: https://keele-repository.worktribe.com/output/796758
• Publisher URL: https://josr-online.biomedcentral.com/articles/10.1186/s13018-024-04741-9