Placebo effects in low back pain: A systematic review and meta-analysis of the literature.

Chronic Pain / drug therapy Humans Low Back Pain / drug therapy Placebo Effect

Journal

European journal of pain (London, England)
ISSN: 1532-2149
Titre abrégé: Eur J Pain
Pays: England
ID NLM: 9801774

Informations de publication

Date de publication:
10 2021
Historique:
pubmed: 30 5 2021
medline: 28 10 2021
entrez: 29 5 2021
Statut: ppublish

Résumé

The current treatments of primary musculoskeletal low back pain (LBP) have a low to moderate efficacy, which might be improved by looking at the contribution of placebo effects. However, the size of true placebo effects in LBP is unknown. Therefore, a systematic review and meta-analysis were executed of randomized controlled trials investigating placebo effects in LBP. The study protocol was registered in the international prospective register of systematic reviews Prospero (CRD42019148745). A literature search (in PubMed, Embase, The Cochrane Library, CINAHL and PsycINFO) up to 2021 February 16th yielded 2,423 studies. Two independent reviewers assessed eligibility and risk of bias. Eighteen studies were eligible for the systematic review and 5 for the meta-analysis. Fourteen of the 18 studies were clinical treatment studies, and 4 were experimental studies specifically assessing placebo effects. The clinical treatment studies provided varying evidence for placebo effects in chronic LBP but insufficient evidence for acute and subacute LBP. Most experimental studies investigating chronic LBP revealed significant placebo effects. The meta-analysis of 5 treatment studies investigating chronic LBP depicted a significant moderate effect size of placebo for pain intensity (SMD = 0.57) and disability (SMD = 0.52). This review shows a significant contribution of placebo effects to chronic LBP symptom relief in clinical and experimental conditions. The meta-analysis revealed that placebo effects can influence chronic LBP intensity and disability. However, additional studies are required for more supporting evidence and evidence for placebo effects in acute or subacute LBP. This systematic review and meta-analysis provides evidence of true placebo effects in low back pain (LBP). It shows a significant contribution of placebo effects to chronic LBP symptom relief. The results highlight the importance of patient- and context-related factors in fostering treatment effects in this patient group. New studies could provide insight into the potential value of actively making use of placebo effects in clinical practice.

Sections du résumé

BACKGROUND AND OBJECTIVE
The current treatments of primary musculoskeletal low back pain (LBP) have a low to moderate efficacy, which might be improved by looking at the contribution of placebo effects. However, the size of true placebo effects in LBP is unknown. Therefore, a systematic review and meta-analysis were executed of randomized controlled trials investigating placebo effects in LBP.
DATABASES AND DATA TREATMENT
The study protocol was registered in the international prospective register of systematic reviews Prospero (CRD42019148745). A literature search (in PubMed, Embase, The Cochrane Library, CINAHL and PsycINFO) up to 2021 February 16th yielded 2,423 studies. Two independent reviewers assessed eligibility and risk of bias.
RESULTS
Eighteen studies were eligible for the systematic review and 5 for the meta-analysis. Fourteen of the 18 studies were clinical treatment studies, and 4 were experimental studies specifically assessing placebo effects. The clinical treatment studies provided varying evidence for placebo effects in chronic LBP but insufficient evidence for acute and subacute LBP. Most experimental studies investigating chronic LBP revealed significant placebo effects. The meta-analysis of 5 treatment studies investigating chronic LBP depicted a significant moderate effect size of placebo for pain intensity (SMD = 0.57) and disability (SMD = 0.52).
CONCLUSIONS
This review shows a significant contribution of placebo effects to chronic LBP symptom relief in clinical and experimental conditions. The meta-analysis revealed that placebo effects can influence chronic LBP intensity and disability. However, additional studies are required for more supporting evidence and evidence for placebo effects in acute or subacute LBP.
SIGNIFICANCE
This systematic review and meta-analysis provides evidence of true placebo effects in low back pain (LBP). It shows a significant contribution of placebo effects to chronic LBP symptom relief. The results highlight the importance of patient- and context-related factors in fostering treatment effects in this patient group. New studies could provide insight into the potential value of actively making use of placebo effects in clinical practice.

Identifiants

DOI: 10.1002/ejp.1811 PMID: 34051018 PMC: PMC8518410
pubmed: 34051018
doi: 10.1002/ejp.1811
pmc: PMC8518410
doi:

Types de publication

Journal Article Meta-Analysis Research Support, Non-U.S. Gov't Review Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1876-1897

Informations de copyright

© 2021 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®.

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Auteurs

Johan Hans Peter Alexander van Lennep (JHPA)

Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Health, Medical and Neuropsychology Unit, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands.

Faye Trossèl (F)

Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.

Roberto Silvio Giovanni Maria Perez (RSGM)

Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.

René Hubert Joseph Otten (RHJ)

Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Henriët van Middendorp (H)

Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Health, Medical and Neuropsychology Unit, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands.

Andrea Walburga Maria Evers (AWM)

Health, Medical and Neuropsychology Unit, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands.
Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
Medical Delta, Leiden University, Technical University Delft, and Erasmus University, Leiden, The Netherlands.

Karolina Maria Szadek (KM)

Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.

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Classifications MeSH

questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Manifestations neurologiques › Douleur chronique › Placebo effects in low back pain: A systematic...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Placebo effects in low back pain: A systematic...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Manifestations neurologiques › Dorsalgie › Lombalgie › Placebo effects in low back pain: A systematic...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Facteurs épidémiologiques › Modificateur d'effet épidémiologique › Effet placebo › Placebo effects in low back pain: A systematic...