Acute Non-specific Low Back Pain Research Articles

Are trunk muscle sizes different between acute lumbar spondylolysis and nonspecific low back pain?

IntroductionMorphological differences in the trunk muscles between adolescent athletes with lumbar spondylolysis (LS) and nonspecific low back pain (NSLBP) have not been fully elucidated. This study aimed to investigate the differences in physiological cross-sectional areas (CSA) of the trunk muscles between athletes with acute LS and those with acute NSLBP. MethodsMagnetic resonance images of 48 patients aged 13–14 years diagnosed with acute LS or NSLBP were retrospectively evaluated. The CSA of the paraspinal, psoas major, and rectus abdominis muscles at the L4-5 intervertebral disc level were measured. ResultsCSA of the left and right paraspinal muscles in the acute LS group were significantly larger than those in the acute NSLBP group (left: mean difference, 276.0 mm2; 95% confidence interval [CI], 68.5–483.6 mm2; P = 0.01; right: mean difference, 228.8 mm2; 95% CI, 7.6–450.1 mm2; P = 0.04). The ratio between the left paraspinal muscles and left psoas major in the acute LS group was significantly larger than that in the acute NSLBP group (mean difference, 0.2; 95% CI, 0.0–0.4; P = 0.03). ConclusionsTrunk muscle size may differ between adolescent athletes with acute LS and those with NSLBP. Future research involving healthy controls is required to better understand the morphological characteristics of these injuries.

The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis.

Understanding the clinical course of low back pain is essential to informing treatment recommendations and patient stratification. Our aim was to update our previous systematic review and meta-analysis to gain a better understanding of the clinical course of acute, subacute and persistent low back pain. To update our 2012 systematic review and meta-analysis, we searched the Embase, MEDLINE and CINAHL databases from 2011 until January 2023, using our previous search strategy. We included prospective inception cohort studies if they reported on participants with acute (< 6 wk), subacute (6 to less than 12 wk) or persistent (12 to less than 52 wk) nonspecific low back pain at study entry. Primary outcome measures included pain and disability (0-100 scale). We assessed risk of bias of included studies using a modified tool and assessed the level of confidence in pooled estimates using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. We used a mixed model design to calculate pooled estimates (mean, 95% confidence interval [CI]) of pain and disability at 0, 6, 12, 26 and 52 weeks. We treated time in 2 ways: time since study entry (inception time uncorrected) and time since pain onset (inception time corrected). We transformed the latter by adding the mean inception time to the time of study entry. We included 95 studies, with 60 separate cohorts in the systematic review (n = 17 974) and 47 cohorts (n = 9224) in the meta-analysis. Risk of bias of included studies was variable, with poor study attrition and follow-up, and most studies did not select participants as consecutive cases. For the acute pain cohort, the estimated mean pain score with inception time uncorrected was 56 (95% CI 49-62) at baseline, 26 (95% CI 21-31) at 6 weeks, 22 (95% CI 18-26) at 26 weeks and 21 (95% CI 17-25) at 52 weeks (moderate-certainty evidence). For the subacute pain cohort, the mean pain score was 63 (95% CI 55-71) at baseline, 29 (95% CI 22-37) at 6 weeks, 29 (95% CI 22-36) at 26 weeks and 31 (95% 23-39) at 52 weeks (moderate-certainty evidence). For the persistent pain cohort, the mean pain score was 56 (95% CI 37-74) at baseline, 48 (95% CI 32-64) at 6 weeks, 43 (95% CI 29-57) at 26 weeks and 40 (95% CI 27-54) at 52 weeks (very low-certainty evidence). The clinical course of disability was slightly more favourable than the clinical course of pain. Participants with acute and subacute low back pain had substantial improvements in levels of pain and disability within the first 6 weeks ( moderate-certainty evidence); however, participants with persistent low back pain had high levels of pain and disability with minimal improvements over time (very low-certainty evidence). Identifying and escalating care in individuals with subacute low back pain who are recovering slowly could be a focus of intervention to reduce the likelihood of transition into persistent low back pain. PROSPERO - CRD42020207442.

For adults with acute or subacute non-specific low back pain, how does McKenzie therapy compare with minimal intervention or manual therapy?

For adults with acute or subacute non-specific low back pain, how does McKenzie therapy compare with minimal intervention or manual therapy?

Management of acute non-specific low back pain in the emergency department: do emergency physicians follow the guidelines? Results of a cross-sectional survey

ObjectivesClinical guidelines for acute non-specific low back pain (LBP) recommend avoiding imaging studies or invasive treatments and to advise patients to stay active. The aim of this study was to...

Non-specific low back pain: principles and algorithms for successful management of patients in real clinical practice

Non-specific low back pain (LBP) occurs in most people at least once in a lifetime. In city polyclinics, every fourth patient complains of LBP. During the COVID-19 pandemic, the prevalence of acute non-specific LBP and chronic LBP have increased due to physical inactivity, chronic stress, and anxiety. Musculoskeletal LBP is the second most common cause of disability. In this regard, it is important to consider modern principles for the diagnosis and treatment of non-specific LBP. Diagnostic algorithms, “red flags” (dangerous symptoms), “yellow flags” (chronification factors) in LBP are discussed. Own clinical cases of patients with LBP with “red flags” are presented. Effective drug and non-drug methods of treatment of LBP are considered: patient education, kinesiotherapy, cognitive-behavioral therapy, manual therapy, the use of non-steroidal anti-inflammatory drugs, muscle relaxants. The role of aceclofenac and tolperisone in the treatment of LBP is discussed, clinical studies data on the efficacy and safety of these drugs in pain syndromes are presented. We present our own clinical observation of the successful management of a patient with chronic non-specific LBP.

Systemic pro- and anti-inflammatory profiles in acute non-specific low back pain: An exploratory longitudinal study of the relationship to six-month outcome.

Pro-inflammatory molecules are thought to underpin the development of chronic low back pain (LBP). Although research has begun to explore the association between pro-inflammatory molecules in acute LBP and long-term outcome, no study has explored the role of anti-inflammatory molecules. We aimed to explore whether levels of systemic pro- and anti-inflammatory molecules 1) changed over a period of six months from the onset of acute LBP; 2) differed between people who were recovered (N = 11) and unrecovered (N = 24) from their episode of LBP at six months; 3) baseline psychological factors were related to inflammatory molecule serum concentrations at baseline, three and six months. We retrospectively included participants with acute LBP included from a larger prospective trial and examined blood samples for the measurement of pro- and anti-inflammatory molecules and measures of pain, disability, and psychological factors at baseline, three and six months. The serum concentrations of pro- and anti-inflammatory molecules did not differ over time when compared between participants who recovered and those who did not recover at six-month follow-up. At three months, the unrecovered group had higher interleukin (IL)-8 and IL-10 serum concentrations than the recovered group. Baseline psychological factors were not related to inflammatory molecules at any time point. This exploratory study showed that levels of systemic inflammatory molecules did not change over the course of LBP, irrespective of whether people were recovered or unrecovered at six months. There was no relationship between acute-stage psychological factors and systemic inflammatory molecules. Further investigation is needed to elucidate the contribution of pro- and anti-inflammatory molecules to long-term LBP outcome.

Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial

Opioid analgesics are commonly used for acute low back pain and neck pain, but supporting efficacy data are scarce. We aimed to investigate the efficacy and safety of a judicious short course of an opioid analgesic for acute low back pain and neck pain. OPAL was a triple-blinded, placebo-controlled randomised trial that recruited adults (aged ≥18 years) presenting to one of 157 primary care or emergency department sites in Sydney, NSW, Australia, with 12 weeks or less of low back or neck pain (or both) of at least moderate pain severity. Participants were randomly assigned (1:1) using statistician-generated randomly permuted blocks to guideline-recommended care plus an opioid (oxycodone-naloxone, up to 20 mg oxycodone per day orally) or guideline-recommended care and an identical placebo, for up to 6 weeks. The primary outcome was pain severity at 6 weeks measured with the pain severity subscale of the Brief Pain Inventory (10-point scale), analysed in all eligible participants who provided at least one post-randomisation pain score, by use of a repeated measures linear mixed model. Safety was analysed in all randomly assigned eligible participants. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615000775516). Between Feb 29, 2016, and March 10, 2022, 347 participants were recruited (174 to the opioid group and 173 to the placebo group). 170 (49%) of 346 participants were female and 176 (51%) were male. 33 (19%) of 174 participants in the opioid group and 25 (15%) of 172 in the placebo group had discontinued from the trial by week 6, due to loss to follow-up and participant withdrawals. 151 participants in the opioid group and 159 in the placebo group were included in the primary analysis. Mean pain score at 6 weeks was 2·78 (SE 0·20) in the opioid group versus 2·25 (0·19) in the placebo group (adjusted mean difference 0·53, 95% CI -0·00 to 1·07, p=0·051). 61 (35%) of 174 participants in the opioid group reported at least one adverse event versus 51 (30%) of 172 in the placebo group (p=0·30), but more people in the opioid group reported opioid-related adverse events (eg, 13 [7·5%] of 174 participants in the opioid group reported constipation vs six [3·5%] of 173 in the placebo group). Opioids should not be recommended for acute non-specific low back pain or neck pain given that we found no significant difference in pain severity compared with placebo. This finding calls for a change in the frequent use of opioids for these conditions. National Health and Medical Research Council, University of Sydney Faculty of Medicine and Health, and SafeWork SA.

Comparative effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain: systematic review and network meta-analysis

ObjectiveTo evaluate the comparative effectiveness and safety of analgesic medicines for acute non-specific low back pain.DesignSystematic review and network meta-analysis.Data sourcesMedline, PubMed, Embase, CINAHL, CENTRAL, ClinicalTrials.gov, clinicialtrialsregister.eu, and World Health...

NON-SPECIFIC BACK PAIN: DIAGNOSIS AND THERAPY FROM THE POSITION OF EVIDENTIAL MEDICINE (REVIEW OF LITERATURE)

The purpose of this publication is an attempt to systematize modern data based on the principles of evidence-based medicine (controlled randomized trials, systematic reviews, meta-analyses) in the field of diagnosis and treatment of non-specific low back pain. It is shown that non-specific lumbar pain is the predominant type of lumbar pain syndrome. The basis for the diagnosis of nonspecific low back pain should be a detailed history taking and a thorough physical and neurological examination. The value of imaging diagnostic methods is limited to patients with red flags. Both in the case of acute and chronic non-specific low back pain, the basis of therapy with well-proven effectiveness is patient education, manipulative techniques and special physical therapy. In the case of chronic non-specific low back pain, behavioral therapy is highly effective. Non-steroidal anti-inflammatory drugs have proven efficacy in relation to pain and functioning of the patient. In the case of chronic non-specific low back pain, muscle relaxants and antidepressants may be additionally prescribed.

Effectiveness of muscle energy technique in patients with nonspecific low back pain: a systematic review with meta-analysis.

Low back pain (LBP) is a major cause of physical disability in the world. The origin of this condition can be due to differents causes, with a specific cause or of unknown mechanical origin,being characterized as unspecific. In this case a physical therapy treatment approach with manual therapy is relevant, which includes the muscle energy technique (MET) classified as a common conservative treatment for pathologies of the spine, mainly in LBP and disability. This study assessed the effectiveness of the muscle energy technique on nonspecific low back pain. Patients with acute, subacute or chronic non-specific low back pain. The primary outcomes were pain and disability. This study was designed by a systematic review and meta-analysis, registered in PROSPERO (CRD42020219295). For the report and methodological definitions of this study, the recommendations of the PRISMA protocol and the Cochrane collaboration, were followed, respectively. The search yielded 164 citations, which 19 were eligible randomised trials were included in the review (N.=609 patients with low back pain). The methodological quality of the studies averaged 4.2 points, with an interval of 2 to 7 points. Three RCTs showed satisfactory methodological quality (PEDro Score ≥6). For patients with chronic LBP, a significant result on pain (but with a small and clinically unimportant effect) in favor of MET versus other (MD=-0.51 [95% CI,-0.93 to -0.09] P=0.02, N.=376, studies=11, I2=80%). In patients with subacute LBP, MET enabled a significant and moderate effect to reduce pain intensity when compared to the control group (MD=-1.32 [95% CI,-2.57 to -0.06] P=0.04, N.=120, studies=3, I2=88%). No significant effects were observed for the disability. MET is not considered an efficient treatment to improve the incapacity of the lumbar spine, but it may be beneficial in reducing the intensity of LBP, although showing a small clinical effect in chronic LBP and a moderate effect in subacute LBP.

Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews

ObjectiveTo summarise the available clinical evidence on the efficacy and safety of osteopathic manipulative treatment (OMT) for different conditions.DesignOverview of systematic reviews (SRs) and meta-analyses (MAs). PROSPERO CRD42020170983.Data sourcesAn electronic...

Developing clinical algorithm for identifying acute lumbar spondylolysis in elementary school children – Classification and regression tree analysis

ABSTRACT Objectives To develop a clinical algorithm for classifying acute lumbar spondylolysis from nonspecific low back pain in elementary school-aged patients using the classification and regression tree analysis. Methods Medical records of 73 school-aged patients diagnosed with acute lumbar spondylolysis or nonspecific low back pain were retrospectively reviewed. Fifty-eight patients were examined for establishing an algorithm and 15 were employed for testing its performance. The following data were retrieved: age, gender, school grades, days after symptom onset, history of low back pain, days of past low back pain, height, weight, body mass index, passive straight leg raise test results, hours per week spent on sports activities, existence of spina bifida, lumbar lordosis angle, and lumbosacral joint angle. Classification and regression tree analyses were performed 150 times using the bootstrap and aggregating method. Then, the results were integrated by majority vote, establishing an algorithm. Results Lumbar lordosis angle, days after symptom onset, body mass index, and lumbosacral joint angle were the predictors for classifying those injuries. Conclusion The algorithm can be used to identify elementary school-aged children with low back pain requiring advanced imaging investigation, although a future study with a larger sample population is necessary for validating the algorithm.

OPAL: a randomised, placebo-controlled trial of opioid analgesia for the reduction of pain severity in people with acute spinal pain—a statistical analysis plan

BackgroundLow back and neck pain are a leading cause of disease burden globally. Opioids are recommended in guidelines for acute low back and neck pain; however, there is a lack of compelling efficacy data to support this.MethodsThe OPAL trial is a prospectively registered, triple-blinded, randomised, placebo-controlled trial. Patients with acute (≤12 weeks duration) back and/or neck pain receive guideline care plus either an opioid (oxycodone + naloxone, up to 20 mg per day) or a placebo for up to 6 weeks or earlier, if pain is resolved. The primary outcome is pain measured using the Pain Severity Score of the Brief Pain Inventory with the primary time point being 6 weeks. Secondary outcomes include physical function, time to recovery, quality of life, adverse events and risk of opioid misuse. Outcomes are collected at weeks 2, 4, 6, 12, 26 and 52. Analysis will be done on an intention-to-treat principle. p values of < 0.05 will be considered significant and 95% confidence intervals will be reported. Repeated-measures linear mixed models will be used to assess the effect of the treatment group on the primary outcome and continuous secondary outcomes. Adverse events will be compared between groups using Fisher’s exact test. Cost-effectiveness analyses will be conducted if a treatment effect on pain is seen at week 6. Subgroup analyses will be performed to assess whether pain duration and pain location are treatment effect modifiers.DiscussionThe OPAL trial will provide important evidence about whether a short course of opioids is effective in the treatment of acute non-specific low back and/or neck pain. This pre-specified statistical analysis plan details the methodology for the analysis of the OPAL trial results.Trial registrationACTRN12615000775516. The trial has completed recruitment. Follow-up on the last patient will be completed in March 2022.

The Prediction of Chronicity in Patients With Acute and Subacute Nonspecific Low Back Pain and Associated Risk Factors: A Case-Control Study

BackgroundChronic low back pain is one of the most common musculoskeletal disorders in different countries. AimsThis study aimed to predict the chronicity of nonspecific acute and nonspecific low back pain (LBP) and related risk factors among cases referred to physiotherapy clinics. DesignA case-control and cross-sectional study. SettingsTwo physiotherapy centers in Tehran, Iran. ParticipantsThis study included 502 patients with acute, subacute and chronic LBP. MethodThis study included 502 patients with acute, subacute and chronic LBP. Data were obtained using the Fear-Avoidance Beliefs Questionnaire, Patient Health Questionnaire, Pain Catastrophic Scale, Tampa Scale for Kinesiophobia, Pittsburgh Sleep Quality Index, Walker's Health-Promoting Lifestyle Questionnaire, Roland Morris Disability Questionnaire, and Numerical Pain Rating Scale. Data analysis was performed by applying independent sample t test, χ2, and multiple logistic regression in SPSS software version 25. IBM Amos version 22 was used for path analysis. ResultsIt was found that some demographic parameters (i.e., weight, BMI, job, type of occupational task performance, history of low back pain, work shift, underlying diseases and income), some cognitive parameters (i.e., fear-avoidance beliefs, kinesiophobia, catastrophic pain, and depression), some lifestyle parameters (i.e., health responsibility, physical activity, and interpersonal relationships), sleep quality and pain related disability were among the most critical risk factors in the chronicity of acute and subacute LBP (p < .05). ConclusionsPersonal, psychological, and psychosocial parameters can be among the most critical predictors in the chronicity of acute and subacute nonspecific LBP. Hence, paying attention to all the mentioned factors at the beginning of patients' treatment to create a targeted treatment algorithm and prevent the conversion of acute and subacute into chronic LBP has particular importance.

Improving adherence to acute low back pain guideline recommendations with chiropractors and physiotherapists: the ALIGN cluster randomised controlled trial

BackgroundAcute low back pain is a common condition, has high burden, and there are evidence-to-practice gaps in the chiropractic and physiotherapy setting for imaging and giving advice to stay active. The aim of this cluster randomised trial was to estimate the effects of a theory- and evidence-based implementation intervention to increase chiropractors’ and physiotherapists’ adherence to a guideline for acute low back pain compared with the comparator (passive dissemination of the guideline). In particular, the primary aim of the intervention was to reduce inappropriate imaging referral and improve patient low back pain outcomes, and to determine whether this intervention was cost-effective.MethodsPhysiotherapy and chiropractic practices in the state of Victoria, Australia, comprising at least one practising clinician who provided care to patients with acute low back pain, were invited to participate. Patients attending these practices were included if they had acute non-specific low back pain (duration less than 3 months), were 18 years of age or older, and were able to understand and read English. Practices were randomly assigned either to a tailored, multi-faceted intervention based on the guideline (interactive educational symposium plus academic detailing) or passive dissemination of the guideline (comparator). A statistician independent of the study team undertook stratified randomisation using computer-generated random numbers; four strata were defined by professional group and the rural or metropolitan location of the practice. Investigators not involved in intervention delivery were blinded to allocation. Primary outcomes were X-ray referral self-reported by clinicians using a checklist and patient low back pain-specific disability (at 3 months).ResultsA total of 104 practices (43 chiropractors, 85 physiotherapists; 755 patients) were assigned to the intervention and 106 practices (45 chiropractors, 97 physiotherapists; 603 patients) to the comparator; 449 patients were available for the patient-level primary outcome. There was no important difference in the odds of patients being referred for X-ray (adjusted (Adj) OR: 1.40; 95% CI 0.51, 3.87; Adj risk difference (RD): 0.01; 95% CI − 0.02, 0.04) or patient low back pain-specific disability (Adj mean difference: 0.37; 95% CI − 0.48, 1.21, scale 0–24). The intervention did lead to improvement for some key secondary outcomes, including giving advice to stay active (Adj OR: 1.96; 95% CI 1.20, 3.22; Adj RD: 0.10; 95% CI 0.01, 0.19) and intending to adhere to the guideline recommendations (e.g. intention to refer for X-ray: Adj OR: 0.27; 95% CI 0.17, 0.44; intention to give advice to stay active: Adj OR: 2.37; 95% CI 1.51, 3.74).ConclusionsIntervention group clinicians were more likely to give advice to stay active and to intend to adhere to the guideline recommendations about X-ray referral. The intervention did not change the primary study outcomes, with no important differences in X-ray referral and patient disability between groups, implying that hypothesised reductions in health service utilisation and/or productivity gains are unlikely to offset the direct costs of the intervention. We report these results with the caveat that we enrolled less patients into the trial than our determined sample size. We cannot recommend this intervention as a cost-effective use of resources.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12609001022257. Retrospectively registered on 25 November 2009

Patient education for acute low back pain : Contents of pain education in patients with acute non-specific low back pain- ascoping review

The objective of the review is to map the content of intervention education in people with acute nonspecific lumbar low back pain (LBP) to make it available in asynopsis. In the care of people with acute non-specific LBP, education is recommended as an elementary treatment component. However, the proposed content is proving to be heterogenic and the question arises as to how education should be designed in the future. Asystematic literature search and content analysis of studies with content on pain education was conducted as part of ascoping review. Inclusion criteria were: provision of relevant information on the content of pain education, patients with acute nonspecific low back pain, 18years or older, publication in English or German. The search was conducted in the Medline, CINAHL, Cochrane Library, and PEDro databases and supplemented by ahand search. The search was completed in February 2021. Atotal of 4239 hits were identified, of which 90studies were included. Awide range of content was found and clustered into ten categories. The most frequent statements were in the categories "recommendations for dealing with LRS," "education, reassuring aspects, and relieving basic messages," and "information and recommendations about medications." The teaching of pathoanatomical information can potentially trigger or increase anxiety and worry, whereas information on neurophysiological mechanisms of pain development and processing is more likely to have an anxiety-reducing effect. The results can contribute to the design of the intervention in different settings.

Psychosocial predictors of persistent low back pain in patients presenting to the emergency department.

Chronic low back pain is an important public health problem, generating high financial and social costs. While most clinical guidelines stress the importance of managing low back pain in primary care, in practice a disproportionate amount of patients with low back pain present to emergency departments. Patients presenting to emergency departments may form a specific group with different factors leading to chronicity. This prospective cohort study aimed to determine the sociodemographic and psychological predictors of persistent low back pain and the length of sick leave due to pain in patients with acute symptoms visiting an emergency department. Patients with a first episode of non-specific acute low back pain in at least three months were qualified for this study. The participants filled a battery of questionnaires, including measures of pain, pain-related disability, depression, anxiety and pain coping strategies. A structured telephone interview was performed after three months with questions regarding pain and the length of sick leave. 110 patients participated in the study. 97 patients completed the follow-up, with 70.1% suffering from pain after three months. Lower self-rated health predicted pain after three months. Longer length of sick leave was predicted by lower self-rated health, distraction as a coping strategy and decreased behavioral activity. Because of its simplicity, a measurement of self-rated health may be included in future clinical practice for assessing the risk of persistent pain.

Evaluation of hematological parameters related to systemic inflammation in acute and subacute/chronic low back pain.

Aim: To compare the hematological parameters associated with systemic inflammation between acute and subacute/chronic nonspecific low back pain and to evaluate their diagnostic roles in relation to chronicity in low back pain. Materials & methods: This retrospective case-control study included 150 participants aged 18-65 years with acute nonspecific low back pain, 150 with subacute/chronic nonspecific low back pain, 150 as the control group. Results: Red cell distribution width was significantly higher in the subacute/chronic pain group compared with the acute pain group (p=0.003), and had a poor diagnostic value for chronicity (cutoff: 11.95, p=0.003). There were no significant differences in terms of other parameters (p>0.05). Conclusion: Red cell distribution width has a poor diagnostic value for chronicity in nonspecific low back pain.

Discriminative and Predictive Analysis of the Brazilian Version of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) Short-Form in Patients With Low Back Pain

ObjectiveThe purpose of this study was to analyze the discriminative and predictive validity of the Brazilian Portuguese version of the Örebro Musculoskeletal Pain Screening Questionnaire Short-Form (ÖMPSQ-Short). MethodsIn this prospective longitudinal cohort study, the ÖMPSQ-Short was administered to 150 patients with acute, subacute, and chronic nonspecific low back pain. A 6-month follow-up was also completed to assess the predictive ability of the questionnaire for risk of pain, disability, and absence from work. The Roland-Morris disability questionnaire, pain numerical rating scale, and additional questions related to work and absence from work were also used. ResultsThe ÖMPSQ-Short cutoff point was determined by analyzing the receiver operating characteristic curve, sensitivity, and specificity, which yielded a value of 44 points for the Brazilian population. Analysis of the 2 × 2 contingency tables showed that the ÖMPSQ-Short correctly classified high-risk patients with pain. Predictive capacity was assessed by univariate linear regression analysis. The ÖMPSQ-Short was able to predict pain, disability, and absence from work in patients with acute pain and disability in patients with subacute pain, and disability and absence from work in patients with chronic pain, but with a small predictive capacity. ConclusionThe ÖMPSQ-Short cutoff demonstrated the ability to classify patients with low and high risk of involvement of psychosocial factors. However, due to its small predictive capacity, we suggest that the ÖMPSQ-Short should not be used to predict pain, disability, and absence from work over 6 months. However, we recommend using it as a guide to discuss the patient's clinical condition.

Cost-effectiveness analysis of acupuncture compared with usual care for acute non-specific low back pain: secondary analysis of a randomised controlled trial.

Objective:To assess the cost-effectiveness of a single treatment session of acupuncture, when applied in addition to usual care for acute low back pain (ALBP).Methods:Secondary analysis of a multicentre randomised controlled trial in Norwegian general practice. In total, 171 participants with ALBP ⩽14 days were randomised to a control group (CG) receiving usual care or to an acupuncture group (AG) receiving one additional session of Western medical acupuncture alongside usual care. Primary outcome measures for this cost-effectiveness analysis were quality-adjusted life years (QALYs), health care costs and societal costs at days 28 and 365, the incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). The NMB was calculated on the basis of the Norwegian cost-effectiveness threshold of NOK 275,000 (USD 35,628) per QALY gained. Missing data were replaced by multiple chained imputation.Results:Eighty-six participants in the CG and 81 in the AG were included in the analysis. We found no QALY gain at day 28. At day 365, the incremental QALY of 0.035 was statistically significant. The differences in health care costs and societal costs were not statistically significant. Three out of four calculations led to negative ICERs (cost saving) and positive NMBs. For the health care perspective at day 365, the ICER was USD –568 per QALY and the NMB was USD 1265, with 95.9% probability of acupuncture being cost-effective.Conclusion:To our knowledge, this is the first cost-effectiveness analysis of acupuncture for ALBP. The findings indicate that acupuncture may be cost-effective from a 1-year perspective, but more studies are needed.Trial registration number:NCT01439412 (ClinicalTrials.gov).