The smallest worthwhile effect on pain intensity of nonsteroidal anti-inflammatory drugs and exercise therapy for acute and chronic low back pain: a benefit-harm trade-off study

Review written by Todd Hargrove info

Key Points

  1. Patients with chronic low back pain estimated that the benefits of individualized exercise would outweigh perceived costs if they reduced pain intensity by 20% better than natural history.
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BACKGROUND & OBJECTIVE

Clinical practice guidelines for low back pain (LBP) commonly recommend exercise and nonsteroidal anti-inflammatory drugs (NSAIDs). Systematic reviews show that both interventions provide small reductions in pain intensity when compared to placebo or no intervention. It is unclear whether LBP patients believe that these benefits outweigh the costs, risks, and/or inconveniences associated with treatment.

This study aimed to clarify this issue by asking LBP patients to estimate the level of pain reduction that would outweigh the perceived costs of each treatment.

Clinical practice guidelines for low back pain commonly recommend exercise and nonsteroidal anti-inflammatory drugs.
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The minimum worthwhile benefit for exercise was a 20% reduction in pain over and above natural history, and a 30% reduction for NSAIDs.

METHODS

The study used the benefit-harm trade-off method to estimate the smallest worthwhile effect of NSAIDs and individualized exercise for treatment of LBP. It recruited 116 people with acute LBP, and 230 people with chronic LBP, and asked them to respond

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