Analgesics have no effect on functional outcome in CLBP patients .
This report has been verified
by one or more authors of the
original publication.
Este estudo foi identificado como tendo um impacto potencialmente elevado.
A métrica de Alto Impacto da OE, baseada em IA, estima a influência que um artigo poderá ter, integrando sinais da revista em que foi publicado e do conteúdo científico do próprio artigo.
Desenvolvido com recurso ao mais avançado processamento de linguagem natural, o modelo High Impact da OE prevê com maior precisão o desempenho futuro de um estudo em termos de citações do que o fator de impacto da revista por si só.
Isto permite o reconhecimento precoce de investigação clinicamente significativa e ajuda os leitores a concentrarem-se nos artigos com maior probabilidade de moldar a prática futura.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(11):36 Eur Spine J. 2014 Apr;23(4):800-650 patients suffering from chronic low back pain were randomized to investigate the effect of acetaminophen and tramadol in achieving favorable outcomes of function, self-reported disability, and pain relief in patients, when compared to a placebo administered over 2 weeks. The evidence presented in this study suggested that the use of acetaminophen and tramadol did not produce significant improvements in functional capacity or self-reported disability when compared to placebo in chronic low back pain patients. Further analysis pertaining to responders observed improved functioning as a result of treatment with analgesics, and responders reported lower catastrophizing scores.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
2/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Sensitization following low back pain (LBP) contributes to chronic pain in the absence of tissue damage, and may result in functional disability. Non-specific LBP is frequently treated with analgesics such as acetaminophens, NSAIDs, tramadol, and opioids, in order to manage pain and restore function. The relationship between pain intensity and functional capacity remains controversial and this study was therefore needed to investigate the effect of a combination of analgesics on functional capacity and disability in chronic low back pain patients (CLBP).
Qual era a principal questão de investigação?
Is a combination of acetaminophen and tramadol over 2 weeks effective in achieving favorable outcomes of function, self-reported disability, and pain relief in patients suffering from CLPB?
- Primary outcome assessments of functional capacity (lifting, carrying, static bending, and dynamic bending) indicated no significant differences between placebo and analgesic groups (all p>0.05).
- 10 (42%) responders reported some or complete pain relief compared to 1 patient in the placebo group (p=0.005).
- Responders indicated a tendency to improve on lifting performance (p=0.10) with a significant reduction of RMDQ (From 12.0 to 10.5; p=0.02).
- Responders demonstrated a significantly lower score on subscale catastrophizing of the PCL (median 35.5 vs. 44.0 in non-responders; p=0.005). No other differences between responders and non-responders were noted.
De que é que me devo lembrar mais?
The use of acetaminophen and tramadol did not produce significant improvements in functional capacity of self-reported disability when compared to placebo in chronic low back pain patients. Note that a subgroup analysis suggested improved functioning as a result of treatment with analgesics, and responders reported lower catastrophizing scores.
Como é que isto afectará o tratamento dos meus doentes?
The evidence presented in this study demonstrated that analgesic treatment with acetaminophen and tramadol did not significantly affect functional outcome in patients suffering from low back. Large scale studies with longer follow-up periods are needed to investigate this relationship further.
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