Objective To assess the effectiveness of interventions for acute and subacute non-specific low back pain (NS-LBP) based on pain and disability outcomes. Design A systematic review of the literature with network meta-analysis. Data sources Medline, Embase and CENTRAL databases were searched from inception until 17 October 2020. Eligibility criteria for selecting studies Randomised clinical trials (RCTs) involving adults with NS-LBP who experienced pain for less than 6 weeks (acute) or between 6 and 12 weeks (subacute). Results Forty-six RCTs (n=8765) were included; risk of bias was low in 9 trials (19.6%), unclear in 20 (43.5%), and high in 17 (36.9%). At immediate-term follow-up, for pain decrease, the most efficacious treatments against an inert therapy were: exercise (standardised mean difference (SMD) −1.40; 95% confidence interval (CI) −2.41 to –0.40), heat wrap (SMD −1.38; 95% CI −2.60 to –0.17), opioids (SMD −0.86; 95% CI −1.62 to –0.10), manual therapy (SMD −0.72; 95% CI −1.40 to –0.04) and non-steroidal anti-inflammatory drugs (NSAIDs) (SMD −0.53; 95% CI −0.97 to –0.09). Similar findings were confirmed for disability reduction in non-pharmacological and pharmacological networks, including muscle relaxants (SMD -0.24; 95% CI -0.43 to -0.04). Mild or moderate adverse events were reported in the opioids (65.7%), NSAIDs (54.3%) and steroids (46.9%) trial arms. Conclusion With uncertainty of evidence, NS-LBP should be managed with non-pharmacological treatments which seem to mitigate pain and disability at immediate-term. Among pharmacological interventions, NSAIDs and muscle relaxants appear to offer the best harm–benefit balance. Data are available in a public, open access repository:

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急性和亚急性机械性非特异性腰痛治疗的有效性：网络荟萃分析的系统评价

目的 评估基于疼痛和残疾结果的急性和亚急性非特异性腰痛 (NS-LBP) 干预措施的有效性。设计 通过网络荟萃分析对文献进行系统回顾。数据来源 Medline、Embase 和 CENTRAL 数据库从开始到 2020 年 10 月 17 日进行了搜索。 选择研究的资格标准 随机临床试验 (RCT) 涉及患有 NS-LBP 且疼痛时间少于 6 周（急性）或 6 至 12 周的成人周（亚急性）。结果 共纳入 46 项 RCT（n=8765）；9 项试验的偏倚风险较低 (19.6%)，20 项试验 (43.5%) 的偏倚风险不明确，17 项试验 (36.9%) 的偏倚风险较高。在近期随访中，对于减轻疼痛，针对惰性治疗最有效的治疗方法是：运动（标准化平均差 (SMD) -1.40；95% 置信区间 (CI) -2。41 至 –0.40），热敷（SMD -1.38；95% CI -2.60 至 –0.17），阿片类药物（SMD -0.86；95% CI -1.62 至 –0.10），手法治疗（SMD -0.72；95% CI - 1.40 至 –0.04) 和非甾体抗炎药 (NSAID) (SMD -0.53；95% CI -0.97 至 –0.09)。在包括肌肉松弛剂在内的非药理学和药理学网络中，类似的发现也被证实可减少残疾（SMD -0.24；95% CI -0.43 至 -0.04）。阿片类药物（65.7%）、非甾体抗炎药（54.3%）和类固醇（46.9%）试验组报告了轻度或中度不良事件。结论由于证据的不确定性，NS-LBP 应该通过非药物治疗来管理，这似乎可以在短期内减轻疼痛和残疾。在药物干预中，非甾体抗炎药和肌肉松弛剂似乎提供了最佳的害处平衡。数据公开，