Evidence map›Paper›PMID 19124635›Full record

ReviewJournal of the American Board of Family Medicine : JABFM

Overtreating chronic back pain: time to back off?

Richard A Deyo, Sohail K Mirza, Judith A Turner, Brook I Martin

4 registry-linked trialsOpen access · bronzeAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of the American Board of Family Medicine : JABFM. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 251 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
251citing papers in PubMed, 8 pooled it
47.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02290223 nacompletednot on this map

Patient Activation to Address Chronic Pain and Opioid Management in Primary Care

TypeinterventionalSponsorKaiser PermanenteRan2015 to 2017Enrolled376ConditionsChronic PainArmsBehavioral Based Treatment Model
NCT03539588 nacompletednot on this map

Trigger Point Dry Needling vs Trigger Point Dry Needling With Intramuscular Electrical Stimulation for the Treatment of Sub-acute and Chronic Low Back Pain in a Military Population: A Randomized Crossover Design

TypeinterventionalSponsorWilliam Beaumont Army Medical CenterRan2017 to 2017Enrolled30ConditionsSub-acute and Chronic Low Back PainArmstrigger point dry needling, Electrical Stimulation
NCT04034004 early_phase1completednot on this map

The Role of Endogenous Opioids in Mindfulness-based Chronic Pain Relief

TypeinterventionalSponsorUniversity of California, San DiegoRan2021 to 2022Enrolled88ConditionsPainArmsMindfulness, Naloxone, Saline, Meditation
NCT04877470 completednot on this map

Baseline-characteristics of Patients Referred to a Secondary Spine Centre

TypeobservationalSponsorZuyderland Medisch CentrumRan2021 to 2023Enrolled4,855ConditionsSpine Disease, Characteristics Disease, Spinal Disease, DemographyArmsConsultation at spine-centre
3 · Its place in the literature

Who cites it

251 citing papers in PubMed, 8 syntheses or guidelines pooled it, 800 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis.The spine journal : official journal of the North American Spine Society · 2018
    Pooled it
  8. Yoga treatment for chronic non-specific low back pain.The Cochrane database of systematic reviews · 2017
    Pooled it
  9. Trial
  10. Trial
  11. Trial
  12. Trial
  13. Trial
  14. Trial
  15. Trial
  16. Trial
  17. Trial
  18. Trial
  19. Trial
  20. Journal of alternative and complementary medicine (New York, N.Y.) · 2020
    Trial

191 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 2 institutions in 1 country.

Richard A DeyoDepartment of Medicine, Oregon Health and Science University, Portland, OR, USA. deyor@ohsu.edu
Sohail K Mirza
Judith A Turner
Brook I Martin
University of Washington · USOregon Health & Science University · US

Funding

Pilot--Synthesis of CT and MR images of cervical spineP60AR048093 · NIAMS · UNIVERSITY OF WASHINGTON · PI DEYO, RICHARD A · 2002 to 2006
$5.1M
Safety of Lumbar Fusion Surgery for Chronic Back PainK23AR048979 · NIAMS · UNIVERSITY OF WASHINGTON · PI MIRZA, SOHAIL K · 2002 to 2006
$626k
NIAMS NIH HHS 5K23AR48979NIAMS NIH HHS 5P60-AR48093NIAMS NIH HHS K23 AR048979NIAMS NIH HHS P60 AR048093
6 · The paper itself

Abstract

Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses. Recent studies document a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates. The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain.

Indexed as

Analgesics, OpioidChronic DiseaseHumansLow Back PainPatient CareSpinal InjuriesTime FactorsAnalgesics, Opioid

Identifiers

PMID19124635
PMCPMC2729142
OpenAlexW2117092285

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.