Conclusions For most clinical tests in LBP there is not consistent evidence for an association with outcome .
Central ization and non-organic signs are exceptions from that .
Background There is a strong tradition of performing a clinical examination of low back pain ( LBP ) patients and this is generally recommended in guidelines .
However , establishing a pathoanatomic diagnosis does not seem possible in most LBP patients and clinical tests may potentially be more relevant as prognostic factors .
The aim of this review of the literature was to systematic ally assess the association between low-tech clinical tests commonly used in adult patients with acute , recurrent or chronic LBP and short- and long-term outcome .
Opioids Compared With Placebo or Other Treatments for Chronic Low Back Pain: An Update of the Cochrane Review
Study Design . Systematic review and meta- analysis . Objective . To assess the efficacy of opioids in adults with chronic low back pain ( CLBP ) . Summary of Background Data . Opioids for CLBP has increased dramatically . However , the benefits and risks remain unclear . Methods . We up date d a 2007 Cochrane Review through October 2012 of r and omized controlled trials from multiple data bases . Use of noninjectable opioids in CLBP for at least 4 weeks was compared with placebo or other treatments ; comparisons with different opioids were excluded . Outcomes included pain and function using st and ardized mean difference ( SMD ) or risk ratios with 95 % confidence intervals ( CIs ) , and absolute risk difference with 95 % CI for adverse effects . Study quality was evaluated using Grading of Recommendations Assessment , Development , and Evaluation criteria . Results . Fifteen trials ( 5540 participants ) , including twelve new , met the criteria . Tramadol was better than placebo for pain ( SMD , −0.55 ; 95 % CI , −0.66 to −0.44 ) and function ( SMD , −0.18 ; 95 % CI , −0.29 to −0.07 ) . Compared with placebo , transdermal buprenorphine  decreased pain ( SMD , −2.47 ; 95 % CI , −2.69 to −2.25 ) , but not function ( SMD , −0.14 ; 95 % CI , −0.53 to 0.25 ) . Strong opioids ( morphine , hydromorphone , oxycodone , oxymorphone , and tapentadol ) , were better than placebo for pain ( SMD , −0.43 ; 95 % CI , −0.52 to −0.33 ) and function ( SMD , −0.26 ; 95 % CI , −0.37 to −0.15 ) . One trial demonstrated little difference with tramadol compared with  celecoxib for pain relief .  Two trials ( 272 participants ) found no difference between opioids and antidepressants for pain or function . Review ed trials had low to moderate quality , high drop-out rates , short duration , and limited interpretability of functional improvement . No serious adverse effects , risks ( addiction or overdose ) , or complications ( sleep apnea , opioid-induced hyperalgesia , hypogonadism ) were reported . Conclusion . There is evidence of short-term efficacy ( moderate for pain and small for function ) of opioids to treat CLBP compared with placebo . The effectiveness and safety of long-term opioid therapy for treatment of CLBP remains unproven . Level of Evidence :
Conclusions For most clinical tests in LBP there is not consistent evidence for an association with outcome .
Central ization and non-organic signs are exceptions from that .
Background There is a strong tradition of performing a clinical examination of low back pain ( LBP ) patients and this is generally recommended in guidelines .
However , establishing a pathoanatomic diagnosis does not seem possible in most LBP patients and clinical tests may potentially be more relevant as prognostic factors .
The aim of this review of the literature was to systematic ally assess the association between low-tech clinical tests commonly used in adult patients with acute , recurrent or chronic LBP and short- and long-term outcome .