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

Trevor Thompson, Sofia Dias, Damian Poulter, Sharon Weldon, Lucy Marsh, Claire Rossato, Jae Il Shin, Joseph Firth, Nicola Veronese, Elena Dragioti, Brendon Stubbs, Marco Solmi, Christopher G. Maher, Andrea Cipriani, John P.A. Ioannidis

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9 Citations (Scopus)


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- A nd 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.

Original languageEnglish
Article number130
JournalSystematic Reviews
Issue number1
Publication statusPublished - 2020 Jun 5

Bibliographical note

Funding Information:
We are extremely grateful to several members of the Lancet Low Back Pain Series Working Group who provided vital commentaries on the most appropriate ways to classify the different CLBP interventions. Specifically, we would like to thank Prof. Judith Turner (University of Washington, USA), Prof. Peter Croft (Keele University, UK), Prof. Douglas Gross (University of Alberta, Canada), Prof. Julie Fritz (University of Utah, USA) and Professor Martin Underwood (University of Warwick, UK) for their invaluable comments. Many thanks also to Cathryn Peppard, a health librarian at the University of Greenwich, for assistance with the construction of search strings. Andrea Cipriani is supported by the National Institute for Health Research (NIHR) Oxford Cognitive Health Clinical Research Facility, by an NIHR Research Professorship (grant RP-2017-08-ST2-006), by the NIHR Oxford and Thames Valley Applied Research Collaboration and by the NIHR Oxford Health Biomedical Research Centre (grant BRC-1215-20005). The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK Department of Health.

Publisher Copyright:
© 2020 The Author(s).

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)


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