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Effectiveness of placebo interventions for patients with nonspecific low back pain: a systematic review and meta-analysis

医学 安慰剂 随机对照试验 物理疗法 荟萃分析 严格标准化平均差 生活质量(医疗保健) 心理干预 置信区间 系统回顾 梅德林 内科学 替代医学 精神科 病理 护理部 法学 政治学
作者
Rob Strijkers,Marco Schreijenberg,Heike Gerger,Bart W. Koes,Alessandro Chiarotto
出处
期刊:Pain [Ovid Technologies (Wolters Kluwer)]
卷期号:162 (12): 2792-2804 被引量:21
标识
DOI:10.1097/j.pain.0000000000002272
摘要

Little is known about the effectiveness of placebo interventions in patients with nonspecific low back pain (LBP). This systematic review assessed the magnitude of the effects of placebo interventions as compared to no intervention in randomized controlled trials (RCTs) including patients with LBP. Embase, MEDLINE (Ovid), and Cochrane CENTRAL databases were searched from inception to December 5, 2019. Randomized controlled trials comparing placebo intervention vs no intervention in adult patients with nonspecific LBP were included. Pain intensity, physical functioning, and health-related quality of life measured at short-term, medium-term, and long-term follow-up were the outcomes of this review. Twenty-one randomized controlled trials were included; one concerning acute LBP and one subacute LBP, whereas 19 studies reported on chronic LBP. In chronic LBP, placebo interventions were more effective than no intervention at short-term follow-up for pain intensity (standardized mean difference = -0.37, 95% confidence interval [CI] = -0.55 to -0.18, moderate-quality evidence), physical functioning (standardized mean difference -0.19, 95% CI = -0.39-0.01, moderate-quality evidence), and physical quality of life (mean difference = -2.71, 95% CI = -4.71-0.71, high-quality evidence), respectively. These effects were not significant at medium-term follow-up, and no data were available at long-term follow-up. These results show placebo interventions are more effective than no intervention at short-term follow-up in patients with chronic LBP. However, the magnitude of the effects is probably not clinically relevant (approximately 8 points on a 0-100 pain scale). Future research should identify effect modifiers and causal mechanisms explaining the short-term effects of placebo interventions in patients with chronic LBP.
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