Hypothesis generation for targeted back pain treatment

Abstract Aim To create a framework for coordinated testing of treatments on the basis of recognizing common back pain diagnostic subgroups. It is hoped that this approach will help get round the lack of progress encountered with therapeutic trials analyzed on the clumped non-specific back pain approach which has tended to show such small treatment effects. Method Examination of standardized deviates of patients’ opinions of previous treatment responses according to their subdiagnosis, which was attributed by subsequent classification analysis. The study was performed on a subsection of 490 patients from those screened for entry into a randomized controlled trial of physiotherapy treatments. The questions about past treatment included the following broad categories: hard bed, hot bath, shortwave diathermy, exercises, traction, manipulation, and injections. The response categories were better, no effect, or worse. The common presentation of cases was divided into prolapsed intervertebral disk, switching back pain, midline-bilaterally equal, facet joint syndrome, strained back and low thoracic. Results There was considerable variation in treatment response according to subgroup membership with no two groups bearing the same profile. Conclusions It is implied that therapeutic trials performed collectively on all-comers grouped as having non-specific back pain, will not reveal the distinctive responses seemingly shown between subgroups. Because of such differences, the response effects will either dilute out because some groups show no response to a particular treatment, or bad responder effects will cancel out the good. While these results are not intended to be definitive, they may afford a basis for coordinating hypotheses to be tested in formal prospective trials.