Abstract
BackgroundThere is limited evidence for the comparative effectiveness of analgesic medicines for adults with low back pain. This systematic review and network meta-analysis aims to determine the analgesic effect, safety, acceptability, effect on function, and relative rank according to analgesic effect, safety, acceptability, and effect on function of a single course of [an] analgesic medicine(s) or combination of these medicines for people with low back pain.MethodsWe will include published and unpublished randomised trials written in any language that compare an analgesic medicine to either another medicine, placebo/sham, or no intervention in adults with low back pain, grouped according to pain duration: acute (fewer than 6 weeks), sub-acute (6 to 12 weeks), and chronic (greater than 12 weeks). The co-primary outcomes are pain intensity following treatment and safety (adverse events). The secondary outcomes are function and acceptability (all-cause dropouts). We will perform a network meta-analysis to compare and rank analgesic medicines. We will form judgements of confidence in the results using the Confidence in Network Meta-Analysis (CINeMA) methodology.DiscussionThis network meta-analysis will establish which medicine, or combination of medicines, is most effective for reducing pain and safest for adults with low back pain.Systematic review registrationPROSPERO CRD42019145257
Highlights
There is limited evidence for the comparative effectiveness of analgesic medicines for adults with low back pain
We will represent the network of trials in a network graph; the size of the node will reflect the total number of participants, the width of each edge will reflect the number of studies presenting direct evidence for the comparison, and the colour of each edge will represent the overall risk of bias
We will compare the effects of competing interventions on pain and function using mean differences (MD) with 95% confidence intervals (CIs) and on safety and acceptability using odds ratios (OR) with 95% Confidence interval (CI)
Summary
There is limited evidence for the comparative effectiveness of analgesic medicines for adults with low back pain. Analgesic medicines include non-steroidal antiinflammatory drugs (NSAIDs), opioids, paracetamol (acetaminophen), anti-convulsants, anti-depressants, muscle relaxants, and corticosteroids These medicines are used in a range of countries [13,14,15,16, 19, 20], but there appear to be no common patterns to prescribing [20]. Comparative effectiveness has been insufficiently described in syntheses of the literature to date [25,26,27,28,29,30,31,32,33,34,35] This is understandable, as most of these systematic reviews [28, 29, 31, 32] investigated a single comparison, usually efficacy, the effect of a medicine compared to sham. Comparative effectiveness data that are limited and lack synthesis have low utility for clinical decision-making
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