Thompson, Trevor ORCID: 0000-0001-9880-782X , Dias, Sofia, Poulter, Damian ORCID: 0000-0003-2521-5959 , Weldon, Sharon Marie ORCID: 0000-0001-5487-5265 , Marsh, Lucy, Rossato, Claire ORCID: 0000-0003-0306-5435 , Shin, Jae Il, Firth, Joseph, Veronese, Nicola, Dragioti, Elena, Stubbs, Brendon, Solmi, Marco, Maher, Christopher G., Cipriani, Andrea and Ioannidis, John P. A. (2020) Efficacy and acceptability of pharmacological and non-pharmacological interventions for non-specific chronic low back pain: a protocol for a systematic review and network meta-analysis. Systematic Reviews, 9:130. ISSN 2046-4053 (Online) (doi:https://doi.org/10.1186/s13643-020-01398-3)

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Abstract

Background: Despite the enormous financial and humanistic burden of chronic low back pain (CLBP), there is little consensus on what constitutes the best treatment options from a multitude of competing interventions. The objective of this network meta-analysis (NMA) is to determine the relative efficacy and acceptability of primary care treatments for non-specific CLBP, with the overarching aim of providing a comprehensive evidence base for informing treatment decisions.

Methods: We will perform a systematic search to identify randomised controlled trials of interventions endorsed in primary care guidelines for the treatment of non-specific CLBP in adults. Information sources searched will include major bibliographic databases (MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO and LILACS) and clinical trial registries. Our primary outcomes will be patient-reported pain ratings and treatment acceptability (all-cause discontinuation), and secondary outcomes will be functional ability, quality of life and patient/physician ratings of overall improvement. A hierarchical Bayesian class-based NMA will be performed to determine the relative effects of different classes of pharmacological (NSAIDs, opioids, paracetamol, anti-depressants, muscle relaxants) and non- pharmacological (exercise, patient education, manual therapies, psychological therapy, multidisciplinary approaches, massage, acupuncture, mindfulness) interventions and individual treatments within a class (e.g. NSAIDs: diclofenac, ibuprofen, naproxen). We will conduct risk of bias assessments and threshold analysis to assess the robustness of the findings to potential bias. We will compute the effect of different interventions relative to placebo/no treatment for both short- and long-term efficacy and acceptability.

Discussion: While many factors are important in selecting an appropriate intervention for an individual patient, evidence for the analgesic effects and acceptability of a treatment are key factors in guiding this selection. Thus, this NMA will provide an important source of evidence to inform treatment decisions and future clinical guidelines.

Item Type:	Article
Uncontrolled Keywords:	Low back pain, network meta-analysis, systematic review, protocol, randomized controlled trial
Subjects:	R Medicine > RS Pharmacy and materia medica
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	08 Jan 2021 22:41
URI:	http://gala.gre.ac.uk/id/eprint/28452

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