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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2024 | Back Pain | Review

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

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

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

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.

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Title: Predictors of success of pharmacological management in patients with chronic lower back pain: systematic review
Authors: Alice Baroncini
Nicola Maffulli
Michael Mian
Raju Vaishya
Francesco Simeone
Filippo Migliorini
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Back Pain
Back Pain
Back Pain
Pregabalin
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-024-04741-9

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Level of evidence

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Evaluating lumbar disc degeneration by MRI quantitative metabolic indicators: the perspective of factor analysis

Opportunistic prediction of osteoporosis in patients with degenerative lumbar diseases: a simplified T12 vertebral bone quality approach

Early efficacy observation of the unilateral biportal endoscopic technique in the treatment of multi-level lumbar spinal stenosis