Lombalgie - Lombosciatalgie
Tableau synthèse efficacité traitements phase aigue et sub-aigue
Tableau synthèse efficacité traitements phase chronique
Acétaminophène
Conclusions: Paracetamol is ineffective in the treatment of low back pain and provides minimal short term benefit for people with osteoarthritis. These results support the reconsideration of recommendations to use paracetamol for patients with low back pain and osteoarthritis of the hip or knee in clinical practice guidelines.
AINS
Conclusions: NSAIDs are effective for spinal pain, but the magnitude of the difference in outcomes between the intervention and placebo groups is not clinically important. At present, there are no simple analgesics that provide clinically important effects for spinal pain over placebo. There is an urgent need to develop new drug therapies for this condition.
Antidépresseurs
Gabapentinoïdes
InterpretatIon: There is moderate- to high-quality evidence that anticonvulsants are ineffective for treatment of low back pain or lumbar radicular pain. There is high-quality evidence that gabapentinoids have a higher risk for adverse events.
CONCLUSIONS AND RELEVANCE: Existing evidence on the use of gabapentinoids in CLBP is limited and demonstrates significant risk of adverse effects without any demonstrated benefit. Given the lack of efficacy, risks, and costs associated, the use of gabapentinoids for CLBP merits caution. There is need for large high-quality trials to more definitively inform this issue.
Trial of pregabalin for acute and chronic sciatica. N Engl J Med 2017;376(12):1111-1120.
Conclusions: Treatment with pregabalin did not significantly reduce the intensity of leg pain associated with sciatica and did not significantly improve other outcomes, as compared with placebo, over the course of 8 weeks. The incidence of adverse events was significantly higher in the pregabalin group than in the placebo group.
Conclusions and relevance: Existing evidence on the use of gabapentinoids in CLBP is limited and demonstrates significant risk of adverse effects without any demonstrated benefit.
Imagerie
Imaging for low back pain, Choosing Wisely
Infophysiopt: prevalence of degenerative lumbar spine imaging findings in asymptômatic individuals
Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. PMID: 25430861; PMCID: PMC4464797.
Tableau
Manipulations vertébrales
Conclusions: Among patients with acute low back pain, spinal manipulation therapy was associated with modest improvements in pain and function at up to 6 weeks, with transient minor musculoskeletal harms. However, heterogeneity in study results was large.
Non-specific low back pain, www.thelancet.com Vol 389 February 18, 2017
Opioïdes
Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. Jones CMP, Day RO, Koes BW, Latimer J, Maher CG, McLachlan AJ, Billot L, Shan S, Lin CC; OPAL Investigators Coordinators. Lancet. 2023 Jun 27:S0140-6736(23)00404-X. doi: 10.1016/S0140-6736(23)00404-X. Epub ahead of print. PMID: 37392748.
Interpretation: Opioids should not be recommended for acute non-specific low back pain or neck pain given that we found no significant difference in pain severity compared with placebo. This finding calls for a change in the frequent use of opioids for these conditions.
Conclusions: In people with chronic low back pain, opioid analgesics provide short and/or intermediate pain relief, though the effect is small and not clinically important even at higher doses. Many trial patients stopped taking the medicine because they did not tolerate or respond to the medicine. There is no evidence on opioid analgesics for acute low back pain or to guide prolonged use of these medicines in the treatment of people with chronic low back pain.
Relaxants musculaires
Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis, A.G. Cashin et al, BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1446 (Published 08 July 2021)
Conclusions: Considerable uncertainty exists about the clinical efficacy and safety of muscle relaxants. Very low and low certainty evidence shows that non-benzodiazepine antispasmodics might provide small but not clinically important reductions in pain intensity at or before two weeks and might increase the risk of an adverse event in acute low back pain, respectively. Large, high quality, placebo controlled trials are urgently needed to resolve uncertainty.
CONCLUSION: Adding baclofen, metaxalone, or tizanidine to ibuprofen does not appear to improve functioning or pain any more than placebo plus ibuprofen by 1 week after an ED visit for acute low back pain.
Conclusion: Among ED patients with acute, nontraumatic, nonradicular low back pain, naproxen+diazepam did not improve functional outcomes or pain compared with naproxen+placebo 1 week and 3 months after ED discharge.
Conclusion: Among ED patients with acute, nontraumatic, nonradicular low back pain, combining naproxen with either orphenadrine or methocarbamol did not improve functional outcomes compared with naproxen+placebo
Thérapies physiques et Exercices
Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial. Pocovi NC, Lin CC, French SD, Graham PL, van Dongen JM, Latimer J, Merom D, Tiedemann A, Maher CG, Clavisi O, Tong SYK, Hancock MJ. Lancet. 2024 Jun 19:S0140-6736(24)00755-4. doi: 10.1016/S0140-6736(24)00755-4. Epub ahead of print. PMID: 38908392.
Interpretation: An individualised, progressive walking and education intervention significantly reduced low back pain recurrence. This accessible, scalable, and safe intervention could affect how low back pain is managed.
A Prospective Observational Study of Emergency Department–Initiated Physical Therapy for Acute Low Back Pain, Howard S Kim, MD MS, Jody D Ciolino, PhD, Nicola Lancki, MPH, Kyle J Strickland, PT DPT, Daniel Pinto, PT PhD, Christine Stankiewicz, PT DPT, D Mark Courtney, MD MSCI, Bruce L Lambert, PhD, Danielle M McCarthy, MD MS, Physical Therapy, , pzaa219, https://doi-org.acces.bibl.ulaval.ca/10.1093/ptj/pzaa219
Conclusion: In this single-center observational study, ED-initiated physical therapy for acute low back pain was associated with improvements in functioning and lower use of high-risk medications compared with usual care; the causality of these relationships remains to be explored.