Nonopioids effective for acute low back pain, review finds

Myorelaxants and NSAIDs with or without acetaminophen were all effective at reducing pain and disability from acute, nonspecific low back pain lasting less than 12 weeks, according to an analysis of 18 randomized controlled trials, although the authors stressed that medications for this condition should always be a second-line strategy.

Myorelaxants, NSAIDs, and NSAIDs with acetaminophen could reduce pain and disability in patients with acute low back pain, a study found.

To determine whether pharmacological management of acute low back pain can effectively reduce pain and disability and, if so, which drugs are the most effective, researchers conducted a systematic review of all randomized controlled trials investigating myorelaxants, NSAIDs, and acetaminophen for acute, nonspecific low back pain lasting less than 12 weeks. Studies that investigated opioids were not considered.

Data from 18 studies and 3,478 patients (mean age, 42.5 years) were available. Mean length of follow-up was 8.0 days, and mean duration of symptoms before treatment was 15.1 days. Pain was evaluated using the numeric rating system or the visual analogue scale, and disability was recorded using a 24-item self-report questionnaire about how low back pain affects activities. Results were published by the Journal of Orthopaedic Research on Feb. 22.

Myorelaxants and NSAIDs were both effective at approximately one week. Myorelaxants, NSAIDs, and NSAIDs combined with acetaminophen were all effective in reducing pain (−2.5 [P=0.0005], −5.0 [P<0.0001], and (−5.8 [P=0.004], respectively) and disability (−4.8 [P=0.03], −10.2 [P<0.0001], and −10.3 [P<0.0001], respectively). NSAIDs plus acetaminophen was associated with a greater improvement than NSAIDs alone, but acetaminophen alone (P=0.1) and placebo (P=0.05) were not effective in reducing pain.

The study authors noted that when treating patients with acute low back pain, it is important to rule out causes that would require specific actions or diagnostics, such as cancer or recent trauma, and said that possible red flags should always be considered. In addition, they wrote, “While this work only focuses on the pharmacological management of acute low back pain, it is fundamental to highlight that the use of drugs should always be a second-line strategy once other nonpharmacological, noninvasive therapies have proved to be insufficient.”