A randomized placebo-controlled trial of desipramine, cognitive behavioral therapy, and active placebo therapy for low back pain

Gould, Hilary; Atkinson, J. Hampton; Chircop-Rollick, Tatiana; D'Andrea, John A.; Garfin, Steven R.; Patel, Shetal; Funk, Stephen D.; Capparelli, Edmund V.; Penzien, Donald; Wallace, Mark; Weickgenanta, Anne L; Slater, Mark A.; Rutledge, Thomas

doi:10.1097/j.pain.0000000000001834

Cited by 21 publications

(10 citation statements)

References 29 publications

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“…Maarrawi 2018 (amitriptyline 5 mg/day) 59 Hameroff 1985 (doxepin 300 mg/day) 55 Atkinson 1998 (nortriptyline 100 mg/day) 73 Gould 2020 (desipramine 15-65 ng/mL) 69 Atkinson 2007 (desipramine 5-242 ng/mL) 71 Jenkins 1976 (imipramine 75 mg/day) 47 Urquhart 2018 (amitriptyline 25 mg/day) 70 16 trials. 17 Our findings are in accordance with those from a previous review of drug treatments for chronic low back pain, which found TCAs and SSRIs to be ineffective and SNRIs to be effective, although the effects were small.…”

Section: Tcas (3-13 Weeks)mentioning

confidence: 99%

Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis

Ferreira

McLachlan

Lin

et al. 2021

BMJ

118

102

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Objective To investigate the efficacy and safety of antidepressants for back and osteoarthritis pain compared with placebo. Design Systematic review and meta-analysis. Data sources Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, International Pharmaceutical Abstracts, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform from inception to 15 November and updated on 12 May 2020. Eligibility criteria for study selection Randomised controlled trials comparing the efficacy or safety, or both of any antidepressant drug with placebo (active or inert) in participants with low back or neck pain, sciatica, or hip or knee osteoarthritis. Data extraction and synthesis Two independent reviewers extracted data. Pain and disability were primary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability). A random effects model was used to calculate weighted mean differences and 95% confidence intervals. Safety (any adverse event, serious adverse events, and proportion of participants who withdrew from trials owing to adverse events) was a secondary outcome. Risk of bias was assessed with the Cochrane Collaboration’s tool and certainty of evidence with the grading of recommendations assessment, development and evaluation (GRADE) framework. Results 33 trials (5318 participants) were included. Moderate certainty evidence showed that serotonin-noradrenaline reuptake inhibitors (SNRIs) reduced back pain (mean difference −5.30, 95% confidence interval −7.31 to −3.30) at 3-13 weeks and low certainty evidence that SNRIs reduced osteoarthritis pain (−9.72, −12.75 to −6.69) at 3-13 weeks. Very low certainty evidence showed that SNRIs reduced sciatica at two weeks or less (−18.60, −31.87 to −5.33) but not at 3-13 weeks (−17.50, −42.90 to 7.89). Low to very low certainty evidence showed that tricyclic antidepressants (TCAs) did not reduce sciatica at two weeks or less (−7.55, −18.25 to 3.15) but did at 3-13 weeks (−15.95, −31.52 to −0.39) and 3-12 months (−27.0, −36.11 to −17.89). Moderate certainty evidence showed that SNRIs reduced disability from back pain at 3-13 weeks (−3.55, −5.22 to −1.88) and disability due to osteoarthritis at two weeks or less (−5.10, −7.31 to −2.89), with low certainty evidence at 3-13 weeks (−6.07, −8.13 to −4.02). TCAs and other antidepressants did not reduce pain or disability from back pain. Conclusion Moderate certainty evidence shows that the effect of SNRIs on pain and disability scores is small and not clinically important for back pain, but a clinically important effect cannot be excluded for osteoarthritis. TCAs and SNRIs might be effective for sciatica, but the certainty of evidence ranged from low to very low. Systematic review registration PROSPERO CRD42020158521.

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Section: Tcas (3-13 Weeks)mentioning

confidence: 99%

Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis

Ferreira

McLachlan

Lin

et al. 2021

BMJ

118

102

View full text Add to dashboard Cite

show abstract

“…All of the 22 studies randomly assigned patients into groups. Random sequence generation was based on computer ( n = 15) [ 23 , 25 , 30 – 33 , 36 – 43 ], random number table [ 24 , 27 ] ( n = 2), toss dice [ 26 ] ( n = 1), third office [ 28 , 29 , 44 ] ( n = 3), and unclear randomization method [ 34 ] ( n = 1). Due to the content of CBT intervention, the participants and CBT providers were not blinded in most studies, whereas the outcome accessors were blinded in most studies.…”

Section: Resultsmentioning

confidence: 99%

“…The minimal clinical significance will be considered if the pain severity was reported to be a 30% reduction from baseline [ 57 ]. Ten of the included studies indicated CBT induced a clinically significant reduction in pain intensity or disability level [ 23 , 24 , 28 , 29 , 32 – 34 , 39 , 43 , 44 ], whereas 7 studies reported limited or no clinical effects [ 25 , 30 , 31 , 35 , 38 , 40 , 41 ]. Five studies did not report the clinical significance of CBT [ 26 , 27 , 36 , 37 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Cognitive Behavioral Therapy on Improving Pain, Fear Avoidance, and Self-Efficacy in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis

Yang

Zheng

et al. 2022

Pain Research and Management

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Background. Cognitive-behavioral therapy (CBT) is commonly adopted in pain management programs for patients with chronic low back pain (CLBP). However, the benefits of CBT are still unclear. Objectives. This review investigated the effectiveness of CBT on pain, disability, fear avoidance, and self-efficacy in patients with CLBP. Methods. Databases including PubMed, EMBASE, Web of Science, Cochrane Library, and PsycINFO were searched. RCTs examining the effects of CBT in adults with CLBP were included. The data about the outcome of pain, disability, fear avoidance, and self-efficacy were retained. Subgroup analysis about the effects of CBT on posttreatment was conducted according to CBT versus control groups (waiting list/usual care, active therapy) and concurrent CBT versus CBT alone. A random-effects model was used, and statistical heterogeneity was explored. Results. 22 articles were included. The results indicated that CBT was superior to other therapies in improving disability (SMD −0.44, 95% CI −0.71 to −0.17, P < 0.05 ), pain (SMD −0.32, 95% CI −0.57 to −0.06, P < 0.05 ), fear avoidance (SMD −1.24, 95% CI −2.25 to −0.23, P < 0.05 ), and self-efficacy (SMD 0.27, 95% CI 0.15 to 0.40, P < 0.05 ) after intervention. No different effect was observed between CBT and other therapies in all the follow-up terms. Subgroup analysis suggested that CBT in conjunction with other interventions was in favor of other interventions alone to reduce pain and disability ( P < 0.05 ). Conclusion. CBT is beneficial in patients with CLBP for improving pain, disability, fear avoidance, and self-efficacy in CLBP patients. Further study is recommended to investigate the long-term benefits of CBT. This meta-analysis is registered with Prospero (registration number CRD42021224837).

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“…Our preliminary study about m-health-based exercise shows that this method is effective for NCLBP but the effect size is not very high. Relevant trials have suggested that psychotherapies such as cognitive behavioral treatment (CBT) [16,17], mindfulness-based stress reduction (MBSR) [18] and self-compassion training (SCT) [19,20] can be effective treatment options for patients with NCLBP. Among them, self-compassion is a state of mind that treats oneself compassionately in the face of pain and stress.…”

Section: Introductionmentioning

confidence: 99%

The Effect of M-Health-Based Core Stability Exercise Combined with Self-Compassion Training for Patients with Nonspecific Chronic Low Back Pain: A Randomized Controlled Pilot Study

Zheng

et al. 2022

Pain Ther

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Introduction: Nonspecific chronic low back pain (NCLBP) is a leading contributor to disease burden worldwide, and the management of NCLBP has always been a problem. This study is designed to explore the feasibility and efficacy of m-health-based core stability exercise (CSE) combined with self-compassion training (SCT) and compare it with m-health-based CSE alone for the management of NCLBP. Methods: This study is a pilot, patient-blinded randomized controlled trial. Participants with NCLBP were randomized into an intervention group and a control group. All the participants received m-health-based CSE, but those in the intervention group also received SCT before CSE.The intervention took place weekly on Saturday or Sunday for 4 weeks in total. Patients selfassessed their outcomes by filling out electronic questionnaires at 4 and 16 weeks after the start of the study. The primary outcome metrics for these questionnaires were back pain disability (based on the Roland-Morris Disability Questionnaire, RMDQ) and Pain intensity (Numeric Rating Scale, NRS; current pain, worst pain, average pain). The secondary outcome metrics were anxiety (GAD-7,7-item Generalized Anxiety Disorder scale), Depression Symptoms (PHQ-9,Patient Health Questionnaire-9), pain catastrophizing (PCS, Pain Catastrophizing Scale) and Self-efficiency (PSEQ, Pain Self-Efficiency Questionnaire). Results: A total of 37 patients comprising 28 (75.7%) females completed the study, with 19 patients in the intervention group and 18 in the control group. The mean (SD) patient age was 35.2 (11.1) years. For all primary outcomes, although there were no significant differences between groups, we found that participants in the intervention group improved function and pain earlier. The RMDQ score changed by -1.771 points (95% CI -3.768 to 0.227) from baseline to 4 weeks in the control group and by -4.822 points (95% CI -6.752 to -2.892) in the intervention group (difference between groups, -3.052 [95% CI -5.836 to -0.267]). Also, the RMDQ score changed by -3.328 points (95% CI -5.252 to -1.403) from baseline to 16 weeks in the control group and by -5.124 points (95% CI -7.014 to -3.233) in Fuming Zheng and Yiyi Zheng are co-first authors.

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A randomized placebo-controlled trial of desipramine, cognitive behavioral therapy, and active placebo therapy for low back pain

Cited by 21 publications

References 29 publications

Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis

Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis

Evaluation of Cognitive Behavioral Therapy on Improving Pain, Fear Avoidance, and Self-Efficacy in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis

The Effect of M-Health-Based Core Stability Exercise Combined with Self-Compassion Training for Patients with Nonspecific Chronic Low Back Pain: A Randomized Controlled Pilot Study

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