Analgesic medicines for adults with low back pain: protocol for a systematic review and network meta-analysis

Wewege, Michael A; Bagg, Matthew K; Jones, Matthew D; McAuley, James H.

doi:10.1186/s13643-020-01506-3

Cited by 5 publications

(16 citation statements)

References 85 publications

(107 reference statements)

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“…CI, confidence interval; N, number of participants; SD, standard deviation; VAS, visual analogue scale on the results from one large study, and suggests that rescaling can also be extended to scales with small ranges (0 to < 10). This is important because approximately 30% of trials included in an ongoing network meta-analysis of analgesic medicines for adults with acute low back pain only used scales with smaller ranges [14]. The majority of these are older trials (published before the year 2000) but some are more recent [35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…We used a dataset of randomised clinical trials that examined analgesic medicines in adults with low back pain from two ongoing network meta-analyses evaluating the comparative effectiveness of analgesic medicines currently licensed by regulatory agencies in the United States, United Kingdom, Europe, and Australia [ 13 , 14 ]. The protocols for these two reviews have been published and provide further detail about the inclusion criteria and search strategies [ 13 , 14 ]. Briefly, we searched electronic databases and clinical trials registers for randomised trials that included adults with acute or chronic non-specific low back pain, which compared an analgesic medicine to either another analgesic medicine, placebo, or no treatment.…”

Section: Methodsmentioning

confidence: 99%

“…Given the limitations of the SMD, many reviews of analgesic medicines in adults with low back pain rescale (also known as convert or transform) all data to a common scale to enable calculation of MD as the pooled estimate [11][12][13][14][15][16][17][18][19][20][21]. These reviews primarily include pain intensity measured on a VAS or NRS, but some also incorporate scales with smaller ranges (e.g., 0 to 3 VRS).…”

Section: Introductionmentioning

confidence: 99%

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Rescaling pain intensity measures for meta-analyses of analgesic medicines for low back pain appears justified: an empirical examination from randomised trials

Wewege

Jones

Williams

et al. 2022

BMC Med Res Methodol

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Objective Meta-analyses of analgesic medicines for low back pain often rescale measures of pain intensity to use mean difference (MD) instead of standardised mean difference for pooled estimates. Although this improves clinical interpretability, it is not clear whether this method is justified. Our study evaluated the justification for this method. Methods We identified randomised clinical trials of analgesic medicines for adults with low back pain that used two scales with different ranges to measure the same construct of pain intensity. We transformed all data to a 0–100 scale, then compared between-group estimates across pairs of scales with different ranges. Results Twelve trials were included. Overall, differences in means between pain intensity measures that were rescaled to a common 0–100 scale appeared to be small and randomly distributed. For one study that measured pain intensity on a 0–100 scale and a 0–10 scale; when rescaled to 0–100, the difference in MD between the scales was 0.8 points out of 100. For three studies that measured pain intensity on a 0–10 scale and 0–3 scale; when rescaled to 0–100, the average difference in MD between the scales was 0.2 points out of 100 (range 5.5 points lower to 2.7 points higher). For two studies that measured pain intensity on a 0–100 scale and a 0–3 scale; when rescaled to 0–100, the average difference in MD between the scales was 0.7 points out of 100 (range 6.2 points lower to 12.1 points higher). Finally, for six studies that measured pain intensity on a 0–100 scale and a 0–4 scale; when rescaled to 0–100, the average difference in MD between the scales was 0.7 points (range 5.4 points lower to 8.3 points higher). Conclusion Rescaling pain intensity measures may be justified in meta-analyses of analgesic medicines for low back pain. Systematic reviewers may consider this method to improve clinical interpretability and enable more data to be included. Study registration/data availability Open Science Framework (osf.io/8rq7f).

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Rescaling pain intensity measures for meta-analyses of analgesic medicines for low back pain appears justified: an empirical examination from randomised trials

Wewege

Jones

Williams

et al. 2022

BMC Med Res Methodol

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“…LBP is the most common musculoskeletal health problem with the highest prevalence in the adult population [ 2 ]. The estimated lifetime prevalence of LBP is up to 80%, meaning many adults will experience an episode of LBP at least once [ 3 ]. According to the Global Burden of Disease Study 2017, LBP was classified as the leading cause of years lived with disability (YLDs) globally.…”

Section: Introductionmentioning

confidence: 99%

The Effect and Safety of Thunder-Fire Moxibustion for Low Back Pain: A Meta-Analysis of Randomized Controlled Trials

Yao

Zhou

Fengqin

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Background. Low back pain (LBP) is considered the leading cause of people living with years of disability worldwide. Notably, thunder-fire moxibustion (TFM) is a new type of moxibustion, which has been widely applied to treat pain syndromes for thousands of years. This study aims to provide evidence to evaluate the effect and safety of TFM in treating LBP. Methods. A systematic search of PubMed, Web of Science, the Cochrane Library, Embase, EBSCO, CNKI, Wanfang Data, CBM, and VIP (until April 2021) was used to identify studies reporting pain intensity, disability, Japanese Orthopedic Association (JOA) score, and quality of life in patients with LBP. Randomized controlled trials (RCTs), which compared TFM and other therapies in LBP, were included. Meanwhile, methodological quality was evaluated using the Cochrane criteria for risk of bias, and the level of evidence was rated utilizing the GRADE approach. Results. Twenty-one RCTs, including 2198 patients, satisfied the inclusion criteria. Compared with other therapies, the effect of TFM was statistically significant, pain intensity decreased (SMD = 0.94; 95% CI (0.74, 1.14); p < 0.00001 ), disability improved (SMD = 1.39; 95% CI (0.19, 2.59); p = 0.02 ), and the JOA score increased (SMD = −1.34; 95% CI (−1.88, −0.80); p < 0.00001 ). It was also reported that the patient’s quality of life improved after treatment for a period of 4 weeks (SMD = −0.29; 95% CI (−0.42, −0.16); p < 0.0001 ) and after a follow-up of 1 month (SMD = −0.20; 95% CI (−0.34, −0.07); p = 0.003 ). The evidence level of the results was determined to be very low to low. Conclusions. Based on the existing evidence, it can be concluded that TFM may have a better effect than other treatments on LBP. However, it is not yet possible to assess the safety level of TFM therapy. Due to the universal low quality of the eligible trials and low evidence level, rigorously designed large-scale RCTs must be conducted in order to further confirm the results in this review.

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Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews

Cashin

Wand

O’Connell

et al. 2023

Cochrane Database of Systematic Reviews

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Analgesic medicines for adults with low back pain: protocol for a systematic review and network meta-analysis

Cited by 5 publications

References 85 publications

Rescaling pain intensity measures for meta-analyses of analgesic medicines for low back pain appears justified: an empirical examination from randomised trials

Rescaling pain intensity measures for meta-analyses of analgesic medicines for low back pain appears justified: an empirical examination from randomised trials

The Effect and Safety of Thunder-Fire Moxibustion for Low Back Pain: A Meta-Analysis of Randomized Controlled Trials

Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews

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