March 28th, 2025

Don't trust the headline

Last week The Guardian (hardly the UK's most sensationalist newspaper) ran a couple of articles 
here  and here based on this paper 

Analgesic effects of non-surgical and non-interventional treatments for low back pain: a systematic review and meta-analysis of placebo-controlled randomised trials

Here's a link, click on the PDF symbol to download

The Guardian take-home, and indeed  the headline of one of the articles is 'only  10% of non-surgical  interventions provide pain-relief', but is this what  the  research paper says?  Spoiler, no it doesn't

The paper is a systematic review of randomised controlled trials comparing individual treatments with a sham or placebo (a sham treatment is not quite the same as a placebo but the idea is  that it mimics the treatment being tested but tries to exclude the supposed active element).  The group had previously undertaken this activity in 2008 and this was an update so the paper aimed to find and add all of the published research since 2008  that met its inclusion and quality criteria.  Papers that didn't quite meet the gold standard would be included but marked down.

Providing sham treatments for manual therapies is difficult  and double blinding (ensuring that neither the practitioner nor patient know whether they are in the active or sham group) is very difficult and so out of the c6500  new studies since this group's previous  version of this paper only c170  met the grade for inclusion 

These papers tended to cluster around interventions  for which a sham or placebo can more easily be contrived such as analgesic drugs and  meridian point acupuncture

There was enough evidence to say that 5  interventions were likely beneficial (they include  spinal manipulation and  massage)  ​

And so, despite  16 years having elapsed since the last systematic review , actually the take home was that there was still  not enough evidence to say how effective  most interventions were