Opioids for chronic low back pain management: a Bayesian network meta-analysis

Migliorini, Filippo; Maffulli, Nicola; Baroncini, Alice; Eschweiler, Jörg; Tingart, Markus; Quack, Valentin

doi:10.1080/17512433.2021.1903316

Cited by 15 publications

(12 citation statements)

References 43 publications

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“…Other strong opioids such as oxycodone or morphine are recommended in the third-line treatment of neuropathic pain, but these agents are rarely utilized due to their high addiction potential [ 112 ]. A recent Bayesian network meta-analysis based on 2933 patients from published randomized controlled trials demonstrated that tapentadol, oxymorphone and fentanyl are the most effective opioids for pain symptoms in patients with chronic low back pain [ 178 ]. However, tramadol was not considered in this meta-analysis.…”

Section: Treatment Strategies For Neuropathic Painmentioning

confidence: 99%

Diagnosis and Management of Neuropathic Pain in Spine Diseases

Bielewicz

Kamieniak

Szymoniuk

et al. 2023

JCM

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Neuropathic pain is generally defined as a non-physiological pain experience caused by damage to the nervous system. It can occur spontaneously, as a reaction to a given stimulus, or independently of its action, leading to unusual pain sensations usually referred to as firing, burning or throbbing. In the course of spine disorders, pain symptoms commonly occur. According to available epidemiological studies, a neuropathic component of pain is often present in patients with spinal diseases, with a frequency ranging from 36% to 55% of patients. Distinguishing between chronic nociceptive pain and neuropathic pain very often remains a challenge. Consequently, neuropathic pain is often underdiagnosed in patients with spinal diseases. In reference to current guidelines for the treatment of neuropathic pain, gabapentin, serotonin and norepinephrine reuptake inhibitors and tricyclic antidepressants constitute first-line therapeutic agents. However, long-term pharmacologic treatment often leads to developing tolerance and resistance to used medications. Therefore, in recent years, a plethora of therapeutic methods for neuropathic pain have been developed and investigated to improve clinical outcomes. In this review, we briefly summarized current knowledge about the pathophysiology and diagnosis of neuropathic pain. Moreover, we described the most effective treatment approaches for neuropathic pain and discussed their relevance in the treatment of spinal pain.

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Section: Treatment Strategies For Neuropathic Painmentioning

confidence: 99%

Diagnosis and Management of Neuropathic Pain in Spine Diseases

Bielewicz

Kamieniak

Szymoniuk

et al. 2023

JCM

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“…Conducting NMA on this topic constitutes a shift towards the highest level of medical evidence. 62 Our NMA has a much broader scope than prior work, such as that concerned solely with pharmacotherapy, [63][64][65][66] exercise training, 15 67 68 traditional Chinese medicine 69 or psychotherapy. 70 73 This underpins the importance of our NMA, as these guidelines do not distinguish whether one treatment is superior to another for this collective of patients with chronic pain.…”

Section: Subgroup and Sensitivity Analysesmentioning

confidence: 99%

Network meta-analysis for comparative effectiveness of treatments for chronic low back pain disorders: systematic review protocol

et al. 2021

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IntroductionChronic low back pain disorders (CLBDs) present a substantial societal burden; however, optimal treatment remains debated. To date, pairwise and network meta-analyses have evaluated individual treatment modes, yet a comparison of a wide range of common treatments is required to evaluate their relative effectiveness. Using network meta-analysis, we aim to evaluate the effectiveness of treatments (acupuncture, education or advice, electrophysical agents, exercise, manual therapies/manipulation, massage, the McKenzie method, pharmacotherapy, psychological therapies, surgery, epidural injections, percutaneous treatments, traction, physical therapy, multidisciplinary pain management, placebo, ‘usual care’ and/or no treatment) on pain intensity, disability and/or mental health in patients with CLBDs.Methods and analysisSix electronic databases and reference lists of 285 prior systematic reviews were searched. Eligible studies will be randomised controlled/clinical trials (including cross-over and cluster designs) that examine individual treatments or treatment combinations in adult patients with CLBDs. Studies must be published in English, German or Chinese as a full-journal publication in a peer-reviewed journal. A narrative approach will be used to synthesise and report qualitative and quantitative data, and, where feasible, network meta-analyses will be performed. Reporting of the review will be informed by Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidance, including the network meta-analysis extension (PRISMA-NMA). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for network meta-analysis will be implemented for assessing the quality of the findings.Ethics and disseminationEthical approval is not required for this systematic review of the published data. Findings will be disseminated via peer-reviewed publication.PROSPERO registration numberPROSPERO registration number CRD42020182039.

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“…Pharmacotherapy is the second step in the management of chronic aspecific LBP [ 6 ]. NSAIDs and opiates represent the most successful treatment options [ 7 , 8 ]. However, potential side-effects of pharmacotherapy, along with the risk of opioids addiction, make this option viable and safe only in the short term.…”

Section: Introductionmentioning

confidence: 99%

Acupuncture in chronic aspecific low back pain: a Bayesian network meta-analysis

et al. 2022

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Background This Bayesian network meta-analysis investigated the available randomized control trials (RCTs) to point out which acupuncture protocol is the most effective for chronic aspecific low back pain (LBP). Efficacy was measured in terms of pain (Visual Analogic Scale, VAS) and disability (Roland Morris Disability Questionnaire, RMQ), Transcutaneous Electrical Nerve Stimulation (TENS). Methods PubMed, Google scholar, Embase, and Scopus were accessed in March 2022. All the RCTs comparing two or more acupuncture modalities for aspecific chronic LBP were accessed. Only studies which investigated the efficacy of acupuncture on patients with symptoms lasting a minimum of 1.5 months, or with at least three episodes in the previous 12 months, were considered eligible. The Review Manager Software (The Nordic Cochrane Collaboration, Copenhagen) was used for the methodological quality assessment. The STATA Software/MP, Version 14.1 (StataCorporation, College Station, Texas, USA), was used for the statistical analyses. The NMA was performed through the STATA routine for Bayesian hierarchical random-effects model analysis. Results Data from 44 RCTs (8338 procedures) were retrieved. 56% of patients were women. The mean age of the patients was 48 ± 10.6 years. The mean BMI was 26.3 ± 2.2 kg/m2. The individual group (95% confidence interval (CI) 2.02, 7.98) and the standard combined with TENS (95% CI 2.03, 7.97) demonstrated the highest improvement of the RMQ. The VAS score was lower in the standard combined with TENS group (95% CI 3.28, 4.56). Considering the standard acupuncture group, different studies used similar protocols and acupuncture points and the results could thus be compared. The equation for global linearity did not find any statistically significant inconsistency in any of the network comparison. Conclusion Verum acupuncture is more effective than sham treatment for the non-pharmacological management of LBP. Among the verum protocols, individualized acupuncture and standard acupuncture with TENS were the protocols that resulted in the highest improvement in pain and quality of life. Level of Evidence Level I, Bayesian network meta-analysis of RCTs.

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Opioids for chronic low back pain management: a Bayesian network meta-analysis

Cited by 15 publications

References 43 publications

Diagnosis and Management of Neuropathic Pain in Spine Diseases

Diagnosis and Management of Neuropathic Pain in Spine Diseases

Network meta-analysis for comparative effectiveness of treatments for chronic low back pain disorders: systematic review protocol

Acupuncture in chronic aspecific low back pain: a Bayesian network meta-analysis

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