Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados

Paracetamol para el dolor lumbar
Bruno T Saragiotto, Gustavo C Machado, Manuela L Ferreira, Marina B Pinheiro, Christina Abdel Shaheed, Christopher G Maher | 6 junio 2016

Topics

Temas

Summary of risk of bias for each of the included trials.
Figuras y tablas -
Figure 1

Summary of risk of bias for each of the included trials.

Ir a la figura de la revisiónAbrir en una pestaña nueva
Summary of findings for the main comparison. Summary of findings table 1: Brazilian arnica extract compared to placebo for patients with non‐specific chronic back pain or soft tissue pain

Brazilian arnica extract compared to placebo for patients with non‐specific chronic back pain or soft tissue pain

Patient or population: patients with back pain

Settings: outpatient clinic

Intervention: extract of Brazilian arnica

Comparison: placebo

Outcomes

No of participants
(trials)

Quality of the evidence
(GRADE)

Comments

Pain reduction based on

Pain VAS instrument 0‐100 scale

20
(one trial)

⊕⊝⊝⊝
very low1

Very small sample size only N = 10 in the treatment group. This trial found that topical application of Brazilian arnica reduced the perception of pain and increased flexibility in the treated group compared to baseline values in that group. Unknown if acute or chronic LBP.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Selection bias was high to unclear, performance bias was low risk to unclear risk, with other attributes being low risk.

Figuras y tablas -
Summary of findings for the main comparison. Summary of findings table 1: Brazilian arnica extract compared to placebo for patients with non‐specific chronic back pain or soft tissue pain
Ir a la tabla de la revisión
Summary of findings 2. Summary of findings table 2: Topical capsaicin cream or plaster compared to placebo for patients with non‐specific chronic back pain or soft tissue pain

Topical capsaicin cream or plaster compared to placebo for patients with non‐specific chronic back pain or soft tissue pain

Patient or population: patients with chronic LBP or soft tissue pain

Settings: Outpatient clinic

Intervention: topical capsicum cream or plaster

Comparison: placebo

Outcomes

No of participants
(trials)

Quality of the evidence
(GRADE)

Comments

Pain perception according to the Pain VAS scale

0‐10

755
(three trials)

⊕⊕⊕⊝
moderate1

All three trials found a statistically significant difference between

the capsaicin intervention vs. placebo. In three trials minor adverse effects were noted in the treatment groups requiring no specific follow‐up treatments.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1All three trials exhibited low to unclear risk in selection bias, performance bias and attrition bias. One trial was at high risk for selective reporting.

Figuras y tablas -
Summary of findings 2. Summary of findings table 2: Topical capsaicin cream or plaster compared to placebo for patients with non‐specific chronic back pain or soft tissue pain
Ir a la tabla de la revisión
Summary of findings 3. Summary of findings table 3: Topical capsaicin cream compared with placebo for patients with acute non‐specific LBP

Topical capsaicin cream compared with placebo for patients with acute non‐specific LBP

Patient or population: patients with acute mechanical LBP

Settings: outpatient clinic

Intervention: Rado‐Salil ointment

Comparison: placebo

Outcomes

No of participants
(trials)

Quality of the evidence
(GRADE)

Comments

Pain evaluation on a 10 cm linear scale

40

(one trial)

⊕⊝⊝⊝
very low1,2

Pain improvements were significantly greater in the capsicum cream group up to day 14. Adverse events: Pruritis, one in placebo, one in Rado‐Salil group. Local erythema and burning, three in the Rado‐Salil group.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Exhibited unclear risk for selection bias as well unclear baseline similarities. Performance bias was low risk as was attrition bias but it was high risk for incomplete outcome data.

2As under 400 participants were included, evidence was downgraded to very low from low.

Figuras y tablas -
Summary of findings 3. Summary of findings table 3: Topical capsaicin cream compared with placebo for patients with acute non‐specific LBP
Ir a la tabla de la revisión
Summary of findings 4. Summary of findings table 4: H. procumbens compared to placebo for non‐specific chronic back pain

H. procumbens compared to placebo for non‐specific chronic back pain

Patient or population: patients with chronic back pain

Settings: outpatient clinic

Intervention:H. procumbens extract

Comparison: placebo

Outcomes

No of participants
(trials)

Quality of the evidence
(GRADE)

Comments

Arhus pain index

scale 0‐130

315
(two trials)

⊕⊕⊝⊝
low1,2

In one trial a 50mg dose of H. procumbens was used, and in

the second trial a 50 mg and 100 mg dose was used with both trialss

showing a significantly improved pain score over placebo.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Both included trials exhibited low risk of bias regarding selection bias with one trial at unclear risk of bias. Performance bias was at low risk of bias, as was attrition bias with one trial at high risk of bias for incomplete outcome data.

2Two trials included under 400 participants and we downgraded the evidence to low from moderate.

Figuras y tablas -
Summary of findings 4. Summary of findings table 4: H. procumbens compared to placebo for non‐specific chronic back pain
Ir a la tabla de la revisión
Summary of findings 5. Summary of findings table 5: H. procumbens extract compared to Vioxx® for non‐specific chronic LBP

H. procumbens extract compared to Vioxx®for non‐specific chronic LBP

Patient or population: patients with chronic LBP

Settings: outpatient clinic

Intervention:H. procumbens extract

Comparison: Vioxx®

Outcomes

No of participants
(trials)

Quality of the evidence
(GRADE)

Comments

Modified Arhus Index

Scale 0‐120

88
(one trial)

⊕⊝⊝⊝
very low1,2

H. procumbens was compared to Vioxx®

and while both groups showed similar pain reduction scores there were no

demonstrable difference among groups. There were adverse effects noted in both

groups.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1This trial was at low risk of bias for all risk of bias factors, with the exception of allocation concealment and compliance which were at unclear risk of bias.

2Downgraded to very low versus low as under 400 participants were included.

Figuras y tablas -
Summary of findings 5. Summary of findings table 5: H. procumbens extract compared to Vioxx® for non‐specific chronic LBP
Ir a la tabla de la revisión
Summary of findings 6. Summary of findings table 6: Willow bark extract compared to placebo for non‐specific chronic LBP

Willow bark extract compared to placebo for non‐specific chronic LBP

Patient or population: patients with chronic LBP

Settings: outpatient clinic and public advertisement

Intervention: willow bark extract

Comparison: placebo

Outcomes

No of participants
(trials)

Quality of the evidence
(GRADE)

Comments

Pain VAS

Scale 0‐10

261
(two trials)

⊕⊕⊕⊝
moderate1,2

The high dose (240 mg) treatment group

showed a significant reduction in pain

scores versus the low dose (120 mg) group

and the placebo group. There was one severe

allergic reaction related to the extract noted.

One trial (N = 51) also examined the effect of

the extract on platelet aggregation.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Both trials were at low to unclear risk for selection bias, low risk for performance bias with one trial exhibiting high risk in baseline characteristics similarity. Both trials were rated as an overall low risk of bias since they met our predetermined cut‐point of 50% of the criteria on which the trial methods were assessed.

2Downgraded from high to moderate as under 400 participants were included between both trials.

Figuras y tablas -
Summary of findings 6. Summary of findings table 6: Willow bark extract compared to placebo for non‐specific chronic LBP
Ir a la tabla de la revisión
Summary of findings 7. Summary of findings table 7: Willow bark extract compared to rofecoxib for non‐specific chronic LBP

Willow bark extract compared to rofecoxib for non‐specific chronic LBP

Patient or population: patients with chronic LBP

Settings: outpatient clinic

Intervention: willow bark extract

Comparison: rofecoxib

Outcomes

No of participants
(one trial)

Quality of the evidence
(GRADE)

Comments

Arhus Index

Scale 0‐130

Pain VAS

Scale 0‐10

228
(one trial)

⊕⊝⊝⊝
very low1,2

There was no significant difference

in the effectiveness and adverse

events between the extract and

rofecoxib.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Low risk for selection bias, high risk for performance bias, and high and low risk for attrition bias.

2Downgraded from low to very low due as under 400 participants were included.

Figuras y tablas -
Summary of findings 7. Summary of findings table 7: Willow bark extract compared to rofecoxib for non‐specific chronic LBP
Ir a la tabla de la revisión
Summary of findings 8. Summary of findings table 8: Comfrey root extract compared to placebo for acute lower and upper back non‐specific pain

Comfrey root extract compared to placebo for acute lower and upper back non‐specific pain

Patient or population: patients with acute lower and upper back pain

Settings: outpatient setting

Intervention: comfrey root extract

Comparison: placebo

Outcomes

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Pain VAS sum (decrease) on active standardized

movement (mm)

120
(one trial)

⊕⊕⊝⊝
low1,2

The root extract showed a statistically

and clinically relevant reduction in

acute back pain versus placebo.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Unclear risk for selection bias, low risk for both performance and attrition bias.

2Downgraded from moderate to low as under 400 participants were included.

Figuras y tablas -
Summary of findings 8. Summary of findings table 8: Comfrey root extract compared to placebo for acute lower and upper back non‐specific pain
Ir a la tabla de la revisión
Summary of findings 9. Summary of findings table 9: Lavender oil acupressure massage and acupoint stimulation compared to usual treatment for acute non‐specific LBP

Lavender oil acupressure massage and acupoint stimulation compared to usual treatment for acute non‐specific LBP

Patient or population: patients with acute LBP

Settings: old aged home and community centre

Intervention: lavender oil massage

Comparison: usual therapy

Outcomes

No of participants
(trials)

Quality of the evidence
(GRADE)

Comments

Pain VAS

0‐10 scale

61
(one trial)

⊕⊝⊝⊝
very low1

One week post‐study the treatment group

showed a significant (P = 0.0001) reduction

in VAS pain as well as improved walking time

and lateral spine flexion range.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Sequence generation was at low risk of bias but allocation concealment was at high risk. Performance bias was at high and unclear risk. Co‐interventions and timing outcome assessment factors were at high risk of bias.

Figuras y tablas -
Summary of findings 9. Summary of findings table 9: Lavender oil acupressure massage and acupoint stimulation compared to usual treatment for acute non‐specific LBP
Ir a la tabla de la revisión
Summary of findings 10. Summary of findings table 10: Spiroflor SRL compared to CCC for chronic non‐specific LBP

Spiroflor SRL compared to CCC for chronic non‐specific LBP

Patient or population: patients with acute and chronic LBP

Settings: outpatient clinic

Intervention: Spiroflor SRL

Comparison: CCC

Outcomes

No of participants
(trials)

Quality of the evidence
(GRADE)

Comments

Pain VAS

0‐100 scale

161
(one trial)

⊕⊝⊝⊝
very low1

Spiroflor SRL and CCC were equally effective in

treating acute LBP but the CCC

group experienced greater adverse events

and adverse drug reactions.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

CCC = Cremor Capsici Compositus FNA; SRL = Homeopathic combination of Symphytum officinale, Rhus toxicodendron and Ledum palustre

1All risk of bias factors were at low risk of bias, except patient compliance which was at high risk.

2Downgraded from low to very low as under 400 participants were included.

Figuras y tablas -
Summary of findings 10. Summary of findings table 10: Spiroflor SRL compared to CCC for chronic non‐specific LBP
Ir a la tabla de la revisión