Abstract:
Background:A 2007 American College of Physicians guideline addressed pharmacologic options for low back pain. New evidence and medications have now become available. Purpose:To review the current evidence on systemic pharmacologic therapies for acute or chronic nonradicular or radicular low back pain. Data Sources:Ovid MEDLINE (January 2008 through November 2016), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and reference lists. Study Selection:Randomized trials that reported pain, function, or harms of systemic medications versus placebo or another intervention. Data Extraction:One investigator abstracted data, and a second verified accuracy; 2 investigators independently assessed study quality. Data Synthesis:The number of trials ranged from 9 (benzodiazepines) to 70 (nonsteroidal anti-inflammatory drugs). New evidence found that acetaminophen was ineffective for acute low back pain, nonsteroidal anti-inflammatory drugs had smaller benefits for chronic low back pain than previously observed, duloxetine was effective for chronic low back pain, and benzodiazepines were ineffective for radiculopathy. For opioids, evidence remains limited to short-term trials showing modest effects for chronic low back pain; trials were not designed to assess serious harms. Skeletal muscle relaxants are effective for short-term pain relief in acute low back pain but caused sedation. Systemic corticosteroids do not seem to be effective. For effective interventions, pain relief was small to moderate and generally short-term; improvements in function were generally smaller. Evidence is insufficient to determine the effects of antiseizure medications. Limitations:Qualitatively synthesized new trials with prior meta-analyses. Only English-language studies were included, many of which had methodological shortcomings. Medications injected for local effects were not addressed. Conclusion:Several systemic medications for low back pain are associated with small to moderate, primarily short-term effects on pain. New evidence suggests that acetaminophen is ineffective for acute low back pain, and duloxetine is associated with modest effects for chronic low back pain. Primary Funding Source:Agency for Healthcare Research and Quality. (PROSPERO: CRD42014014735).
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Chou R,Deyo R,Friedly J,Skelly A,Weimer M,Fu R,Dana T,Kraegel P,Griffin J,Grusing Sdoi
10.7326/M16-2458subject
Has Abstractpub_date
2017-04-04 00:00:00pages
480-492issue
7eissn
0003-4819issn
1539-3704pii
2603229journal_volume
166pub_type
杂志文章,评审abstract:Background:Patients desire information about health care costs because they are increasingly responsible for these costs. Public Web sites that offer cost information could inform provider-patient discussions of costs at the point of care. Objective:To evaluate tools to facilitate the use of publicly available cost in...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
doi:10.7326/M18-2223
更新日期:2019-05-07 00:00:00
abstract::A 53-year-old librarian had recurrent palpable purpura on her ankles and legs that was found to be caused by the fumes released from heat-activated photocopy paper at her place of employment. Behenic acid was identified as the responsible chemical component through a series of challenge studies that simulated her work...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-98-3-320
更新日期:1983-03-01 00:00:00
abstract:OBJECTIVE:To determine if polyvalent IgG is promising therapy for severe IgG nephropathy. DESIGN:Open prospective cohort study. SETTING:Referral nephrology unit. PATIENTS:11 adult patients with severe IgA nephropathy (9 who had idiopathic disease and 2 who had Henoch-Schönlein purpura) and indicators of poor prognos...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-120-6-199403150-00005
更新日期:1994-03-15 00:00:00
abstract:BACKGROUND:Alleviating the problems faced by dying persons and their families has drawn substantial public attention, but little is known about the experience of dying. OBJECTIVE:To characterize the experience of dying from the perspective of surrogate decision makers, usually close family members (89%). DESIGN:Prosp...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
doi:10.7326/0003-4819-126-2-199701150-00001
更新日期:1997-01-15 00:00:00
abstract:BACKGROUND:Each year, millions of patients worldwide have a perioperative myocardial infarction (MI) after noncardiac surgery. OBJECTIVE:To examine the characteristics and short-term outcome of perioperative MI. DESIGN:Cohort study. (ClinicalTrials.gov registration number: NCT00182039) SETTING:190 centers in 23 coun...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
doi:10.7326/0003-4819-154-8-201104190-00003
更新日期:2011-04-19 00:00:00
abstract:BACKGROUND:Tobacco use is the leading cause of preventable death in the United States. PURPOSE:To review the effectiveness and safety of pharmacotherapy and behavioral interventions for tobacco cessation. DATA SOURCES:5 databases and 8 organizational Web sites were searched through 1 August 2014 for systematic review...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/M15-0171
更新日期:2015-10-20 00:00:00
abstract:UNLABELLED:Chinese translation BACKGROUND:Black persons are more likely than white persons to be diagnosed with colorectal cancer and to die from it. The extent to which genetic or biological factors versus disparities in screening rates explain this variance remains controversial. OBJECTIVE:To define the prevalence ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-159-1-201307020-00004
更新日期:2013-07-02 00:00:00
abstract::Early defibrillation is the most important determinant of survival for victims of cardiac arrest due to ventricular fibrillation. The automated external defibrillator (AED) was developed as the result of the American Heart Association's Public Access Defibrillation initiative. The goal of this initiative is to place A...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-135-11-200112040-00011
更新日期:2001-12-04 00:00:00
abstract::Five of 70 patients with systemic lupus erythematosus seen over a 5-year period had peripheral blood films suggestive of hyposplenism. Technetium-99m-sulfur colloid scans showed no splenic activity in three patients. One of these three patients, who had a spontaneous remission of persistent thrombocytopenia concurrent...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-96-1-40
更新日期:1982-01-01 00:00:00
abstract::We studied the clinical and laboratory characteristics of 71 patients with hairy cell leukemia to ascertain whether prognostic factors important for the therapy of the disease existed. Granulocytopenia of less than 500/mu 1 was associated with the occurrence of a serious infection in 46% of the patients, compared to 1...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-89-5-677
更新日期:1978-11-01 00:00:00
abstract:DESCRIPTION:Although approximately 85 million units of red blood cells (RBCs) are transfused annually worldwide, transfusion practices vary widely. The AABB (formerly, the American Association of Blood Banks) developed this guideline to provide clinical recommendations about hemoglobin concentration thresholds and othe...
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引,评审
doi:10.7326/0003-4819-157-1-201206190-00429
更新日期:2012-07-03 00:00:00
abstract:BACKGROUND:Tumor necrosis factor-alpha is present in arteries in giant cell arteritis. OBJECTIVE:To evaluate the efficacy of infliximab, an anti-tumor necrosis factor-alpha agent, in giant cell arteritis. DESIGN:Randomized, controlled trial. SETTING:22 sites in the United States, the United Kingdom, Belgium, Italy, ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-146-9-200705010-00004
更新日期:2007-05-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the efficacy of continuous intravenous infusion of prostacyclin (epoprostenol) in primary pulmonary hypertension. DESIGN:Randomized trial with 8-week treatment periods and nonrandomized treatment for up to 18 months. SETTING:Four referral centers. PATIENTS:Sequential sample of 24 patient...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-112-7-485
更新日期:1990-04-01 00:00:00
abstract:BACKGROUND:Successful outcomes after cardiopulmonary resuscitation remain disappointingly infrequent, in animal studies, administration of exogenous vasopressin during closed- and open-chest cardiopulmonary resuscitation has recently been shown to be more effective than optimal doses of epinephrine in improving vital o...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-124-12-199606150-00006
更新日期:1996-06-15 00:00:00
abstract::Physical symptoms account for more than half of all outpatient visits, but the specific causes and treatments of many common symptoms are frequently not well established. Because clinical research has primarily targeted specific diseases, symptoms-based research is still an emerging field of scientific inquiry, and op...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-134-9_part_2-200105011-00008
更新日期:2001-05-01 00:00:00
abstract::Clinical features of 99 patients with staphylococcal infection were reviewed, and sera were tested by solid-phase radioimmunoassay and gel diffusion for staphylococcal antibodies to ascertain whether these variables predict the extent of infection and the need for prolonged therapy. Clinical features, including the pr...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-89-4-467
更新日期:1978-10-01 00:00:00
abstract::Medical school graduates are avoiding primary care. The very aspects that once attracted students have been subverted. The breadth of practice that was once appealing has become the breadth of heavy-handed scrutiny, as politicians and business leaders have demanded quality--simplistically defined as dogmatic adherence...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-150-10-200905190-00011
更新日期:2009-05-19 00:00:00
abstract::The presence of a low anion gap in patients with multiple myeloma has recently been emphasized. This has been related to the retention of chloride and bicarbonate anions to offset the cationic charge of the monoclonal immunoglobulins. We now report the presence of a low anion gap in 50 patients with asymptomatic plasm...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-86-3-304
更新日期:1977-03-01 00:00:00
abstract::Between 20 July and 15 Octoboer 1975, five cases of human infection with Babesia microti were diagnosed on Nantucket Island, Massachusetts. The illness was characterized by fever, drenching sweats, shaking chills, myalgia, arthralgia, extreme fatigue, and a mild-to-moderate hemolytic anemia. None of the patients had a...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-86-1-6
更新日期:1977-01-01 00:00:00
abstract::Anxiety commonly accompanies serious illness. However, in some patients anxiety is the primary manifestation of illness. Diagnostic criteria for these "primary" anxiety disorders have been redefined in the most recent revision of the American Psychiatric Association's Diagnostic and Statistical Manual. We discuss thes...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-100-4-558
更新日期:1984-04-01 00:00:00
abstract::Vasodilator drugs were initially administered to patients with primary pulmonary hypertension based on the unproven hypothesis that pulmonary vasoconstriction played an important role in the pathogenesis of the disease. There were early reports of hemodynamic and clinical improvement after treatment with various vasod...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-103-2-258
更新日期:1985-08-01 00:00:00
abstract::More than 18 million Americans currently have diabetes mellitus. The economic and human cost of the disease is devastating. In the United States, diabetes is the most common cause of blindness among working-age adults, the most common cause of nontraumatic amputations and end-stage renal disease, and the sixth most co...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-140-11-200406010-00036
更新日期:2004-06-01 00:00:00
abstract:OBJECTIVE:To describe the relation between glycated hemoglobin and the incidence or progression, or both, of diabetic microvascular complications in persons with insulin-dependent (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). DESIGN:Population-based on cohort study. SETTING:An 11-county area in southern...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-124-1_part_2-199601011-00003
更新日期:1996-01-01 00:00:00
abstract::Coronary artery spasm is an important pathogenetic mechanism in some forms of myocardial ischemic disease. Factors that may be important in the genesis of spasm include the autonomic nervous system, prostaglandins, endoperoxides, thromboxanes, and the calcium availability to the contractile apparatus. Spasm results in...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-91-3-441
更新日期:1979-09-01 00:00:00
abstract::Active-control noninferiority trials are being performed with increasing frequency when standard placebo-controlled trials are considered unethical. Three attributes are optimally required to establish noninferiority: 1) The treatment under consideration exhibits therapeutic noninferiority to the active control; 2) th...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-145-1-200607040-00011
更新日期:2006-07-04 00:00:00
abstract:OBJECTIVE:To describe the diagnostic difficulties, response to therapy, and clinical features of lymphomatoid papulosis and the cumulative frequency of transformation to lymphoma. DESIGN:Case series. SETTING:University hospitals. METHODS:The records of 21 patients with lymphomatoid papulosis who were seen from 1986 ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-122-3-199502010-00009
更新日期:1995-02-01 00:00:00
abstract::Because the cholesterol-rich very low density (VLD) lipoproteins of subjects with type III hyperlipoproteinemia are distinctively enriched in apolipoprotein E, a radial immunodiffusion assay for apolipoprotein E in whole plasma was developed. Its diagnostic usefulness was tested in randomly selected (n = 174) and hype...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-87-5-509
更新日期:1977-11-01 00:00:00
abstract:BACKGROUND:Pharmaceutical companies and other trial sponsors must submit certain trial results to ClinicalTrials.gov. The validity of these results is unclear. PURPOSE:To validate results posted on ClinicalTrials.gov against publicly available U.S. Food and Drug Administration (FDA) reviews on Drugs@FDA. DATA SOURCES...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M15-2658
更新日期:2016-09-20 00:00:00
abstract:OBJECTIVE:To assess the efficacy and toxicity of moricizine in treating patients with serious ventricular arrhythmias and inducible sustained ventricular tachycardia. DESIGN:Uncontrolled clinical trial. SETTING:The intensive care and telemetry units of Northwestern Memorial Hospital, St. Francis Hospital and Medical ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-116-5-375
更新日期:1992-03-01 00:00:00
abstract:BACKGROUND:Many nonpharmacologic therapies are available for treatment of low back pain. PURPOSE:To assess benefits and harms of acupuncture, back schools, psychological therapies, exercise therapy, functional restoration, interdisciplinary therapy, massage, physical therapies (interferential therapy, low-level laser ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析,评审
doi:10.7326/0003-4819-147-7-200710020-00007
更新日期:2007-10-02 00:00:00