Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain

Letters5 December 2017Noninvasive Treatments for Acute, Subacute, and Chronic Low Back PainLisa H. Le, MD and Robert G. Badgett, MDLisa H. Le, MDUniversity of Kansas School of Medicine—Wichita, Wichita, Kansas (L.H.L., R.G.B.)Search for more papers by this author and Robert G. Badgett, MDUniversity of Kansas School of Medicine—Wichita, Wichita, Kansas (L.H.L., R.G.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0472 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We are concerned about Qaseem and colleagues' (1) recommendation of tramadol as second-line pharmacotherapy for chronic back pain. We acknowledge that the guideline labels this recommendation as “weak” and supported by “moderate” evidence; however, we suggest that tramadol not be recommended at all, because the underlying evidence rests on unregistered trials of short duration.We updated the Cochrane meta-analysis on which the guideline was based (2) and completed the search, with a mix of methods, for newer trials. We subgrouped these trials on the basis of whether they were registered before execution. Our results are available at ...References1. Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians.. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166:514-30. [PMID: 28192789]. doi:10.7326/M16-2367 LinkGoogle Scholar2. Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC. Opioids compared to placebo or other treatments for chronic low-back pain. Cochrane Database Syst Rev. 2013:CD004959. [PMID: 23983011] doi:10.1002/14651858.CD004959.pub4 CrossrefMedlineGoogle Scholar3. Kaplan RM, Irvin VL. Likelihood of null effects of large NHLBI clinical trials has increased over time. PLoS One. 2015;10:e0132382. [PMID: 26244868] doi:10.1371/journal.pone.0132382 CrossrefMedlineGoogle Scholar4. Prasad V, Berger VW. Hard-wired bias: how even double-blind, randomized controlled trials can be skewed from the start [Editorial]. Mayo Clin Proc. 2015;90:1171-5. [PMID: 26277702] doi:10.1016/j.mayocp.2015.05.006 CrossrefMedlineGoogle Scholar5. Lee JH, Lee CS; Ultracet ER Study Group.. A randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of the extended-release tramadol hydrochloride/acetaminophen fixed-dose combination tablet for the treatment of chronic low back pain. Clin Ther. 2013;35:1830-40. [PMID: 24183364] doi:10.1016/j.clinthera.2013.09.017 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Kansas School of Medicine—Wichita, Wichita, Kansas (L.H.L., R.G.B.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0472. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoNoninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Timothy J. Wilt , Robert M. McLean , Mary Ann Forciea , and Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain Ivan Vucina Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain Jeremy D. Whyman and Rosanne M. Leipzig Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain Sandeep Vijan , Scott Manaker , and Amir Qaseem Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain Donald M. Marcus Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain Alain Braillon Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain Mark Collen Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain Donald R. Murphy , Michael J. Schneider , Christopher G. Bise , and Brian Justice Metrics 5 December 2017Volume 167, Issue 11Page: 834KeywordsArchivesConflicts of interestDisclosureDrug therapyIntent to treat analysisLower back painVisual analog scale ePublished: 5 December 2017 Issue Published: 5 December 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...