Low back pain may be difficult to self-manage, study says

Self-management has small effects on pain and disability in people with low back pain, according to a study published online in Arthritis Care & Research.

“We found very few trials that tested self-management for low back pain, and in many of the trials we had some concerns about the adequacy of the self-management programs that were tested,” Vinicius Cunha Oliveira, PhD candidate, Arthrithis & Musculoskeletal Research Group, The University of Sydney, Australia, told Formulary. “Acknowledging those limitations, the effects of self-management on pain and disability seemed small, questioning whether or not it is a worthwhile approach.

“There is a growing awareness that low back pain is a long-term condition and that self-management can potentially decrease the burden of this condition,” Oliveira continued. “However, evidence of the effectiveness of self-management of low back pain was unclear.”

Oliveira and colleagues performed a systemic review searching the Medline, Embase, CINAHL, PsycINFO, LILACS, PEDro, AMED, SPORTDIScus, and Cochrane databases from the earliest record to April 2011, that included participants with low back pain of any duration. The researchers included trials in which at least 1 intervention for low back pain was named as “self-management” or “self-care.” Eligible studies were assessed for methodological quality using the PEDro scale, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system was used to summarize the strength of the recommendation for each outcome.

The weighted mean difference at short-term follow-up for pain was -3.2 points on a 0–100 scale (95% CI, -5.1, -1.3) and for disability was -2.3 points (95% CI, -3.7, -1.0). The long-term effects were -4.8 (95% CI, -7.1, -2.5) for pain and -2.1 (95% CI, -3.6, -0.6) for disability.

THE FIRST REVIEW

“This was the first review in this area,” he said. “The findings challenge endorsement of self-management for low back pain. Unfortunately, self-management does not help much in low back pain.

“We caution that it would be premature to completely dismiss self-management. We recommend establishing the definition of self-management for low back pain as well as the features of self-management programs by consensus. Research should further understand self-management for low back pain and if specific features may increase its effectiveness.” ■

For more on low back pain, go to http://www.ncbi.nlm.nih.gov/pubmed/22623349