Why I ’ m not fazed by unremarkable results in therapy trials

Remember the old ‘pareto principle’? 80% of the results come from 20% of the input, or as Wikipedia informs me, “the principle of factor sparsity” I think we’ve got there with musculoskeletal pain, especially low back pain. The other ‘law’ that might apply is that of diminishing returns. We’ve learned a great deal about low back pain over my clinical career. We’ve essentially learned what not do to. In the name of progress, thousands of people have put their pain (their bodies) on the line. And progress has not exactly been great right? We’ve learned that paracetamol (acetaminophen) does diddly squat for acute low back pain, and this doesn’t change as pain hangs around (Williams, et al., 2014). We’ve also found out that doing surgery for most back pain isn’t a great thing (except for radicular pain where surgery is better for leg pain than back pain itself) (Chou et al., 2009). We’ve found out that all forms of exercise are great – loads and loads of studies showing this – BUT effect sizes (in other words, how effective it is) are small to modest for both pain and disability. And the most recent study of cognitive functional therapy, while absolutely wonderful and pragmatic and all, is not much different from what has been advocated for at least 30 years while I’ve been in practice (Kent et al., 2023). Now before Defenders of the Faith accuse me of complete nihil...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Back pain Low back pain Occupational therapy Pain conditions Physiotherapy Professional topics Research Science in practice healthcare Therapeutic approaches Source Type: blogs