Chronic back pain is an important health problem. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat people with low back pain, especially people with acute back pain.
Chronic low back
pain is very common and it may cause pain and disability. NSAIDs are majorly
used to treat people suffering with chronic low back pain and many of these
drugs are available over the counter as well as with prescription. This
intensive research is based on the comparison of NSAIDs and the placebo
treatment drawing their efficacy for low back pain. It is based on general
practice and outpatient clinic.
Chronic back pain
is an important health problem. Non-steroidal anti-inflammatory drugs (NSAIDs)
are widely used to treat people with low back pain, especially people with
acute back pain.
To determine if
NSAIDs are more efficacious than various comparison treatments for non-specific
chronic low back pain and if so, which type of NSAID is most efficacious.
We searched
CENTRAL, MEDLINE, EMBASE, PubMed and two clinical trials registry databases up
to 24 June 2015 for randomized controlled trials (RCTs) published in English,
German or Dutch. We also screened references cited in relevant reviews.
We included RCTs
(double-blind and single-blind) of NSAIDs used to treat people with chronic low
back pain.
Two review
authors independently screened trials for inclusion in this Cochrane review
according to the inclusion criteria. One review author extracted the data, and
a second review author checked the data. Two review authors independently
evaluated the risk of bias of all included trials. If data were clinically
homogeneous, we performed a meta-analysis and assessed the quality of evidence
using the GRADE approach.
We included 13
trials in this Cochrane review. Ten studies were at 'low' risk of bias. Six
studies compared NSAIDs with placebo, and included 1354 participants in total.
There is low quality evidence that NSAIDs are more effective than placebo, with
a mean difference in pain intensity score from baseline of -3.30 (95% CI −5.33
to −1.27) on a 0 to 100 visual analogue scale (VAS) with a median follow-up of
56 days (interquartile range (IQR) 13 to 91 days). Four studies measured
disability using the Roland Morris Disability Questionnaire. There is low
quality evidence that NSAIDs are more effective than placebo on disability,
with a mean difference from baseline of −0.85 (95% CI −1.30 to −0.40) on a
scale from 0 to 24 with a median follow-up of 84 days (IQR 42 to 105 days). All
six placebo controlled studies also reported adverse events, and suggested that
adverse events are not statistically significant more frequent in participants
using NSAIDs compared to placebo (RR 1.04, 95% CI 0.92 to 1.17). Due to the
relatively small sample size and relatively short follow-up in most included
trials, it is likely that the proportion of patients experiencing an adverse
event is underestimated.
Two studies
compared different types of non-selective NSAIDs, namely ibuprofen versus
diclofenac and piroxicam versus indomethacin. The trials did not find any
differences between these NSAID types, but both trials had small sample sizes.
One trial reported no differences in pain intensity between treatment groups
that used selective or non-selective NSAIDs. One other trial compared
diflunisal with paracetamol and showed no difference in improvement from
baseline on pain intensity score. One trial showed a better global improvement
in favour of celecoxib versus tramadol.
One included
trial compared NSAIDs with 'home-based exercise'. Disability improved more in
participants who did exercises versus participants receiving NSAIDs, but pain
scores were similar.
Six of the 13
included RCTs showed that NSAIDs are more effective than placebo regarding pain
intensity. NSAIDs are slightly more effective than placebo regarding
disability. However, the magnitude of the effects is small, and the level of
evidence was low. When we only included RCTs at low risk of bias, differences
in effect between NSAIDs and placebo were reduced. We identified no difference
in efficacy between different NSAID types, including selective versus
non-selective NSAIDs. Due to inclusion of RCTs only, the relatively small
sample sizes and relatively short follow-up in most included trials, we cannot
make firm statements about the occurrence of adverse events or whether NSAIDs
are safe for long-term use.
Cochrane Database Syst Rev. 2016 Feb 10;2:CD01208
Non-steroidal anti-inflammatory drugs for chronic low back pain
Enthoven WT et al.
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