Which Nonopioid Meds Are Best for Easing Acute Low Back Pain?
Based on data from more than 3000 people, muscle relaxants and nonsteroidal anti-inflammatory drugs (NSAIDs) improved acute back pain symptoms after one week of treatment.
Acute low back pain (LBP) remains a common cause of disability worldwide with a high socioeconomic burden, write Alice Baroncini, MD, of RWTH-Universitätsklinikum Aachen, Germany, and colleagues.
In an analysis published in the Journal of Orthopedic Research, A team of researchers from Germany investigated which non-opioid drugs are best suited to treat LBP.
The researchers identified 18 studies involving a total of 3478 patients with acute low back pain lasting less than 12 weeks. They selected studies examining only the lumbar spine, and studies involving opioids were excluded. The mean age of the patients in all studies was 42.5 years and 54% were women. The mean duration of symptoms before treatment was 15.1 days.
Overall, muscle relaxants and NSAIDs showed efficacy in relieving pain and disability in acute LBP patients after approximately 1 week of use.
Additionally, studies using a combination of NSAIDs and acetaminophen (aka acetaminophen) showed greater improvement than NSAIDs alone, but acetaminophen/acetaminophen alone had no significant effect on LBP.
Most patients with acute LBP experience spontaneous recovery and reduction in symptoms, so the actual effect of most drugs is uncertain, the researchers write in their discussion. The lack of a placebo effect in the selected studies supports the hypothesis that non-opioid drugs improve LBP symptoms, they say.
“Although this work focuses only on the pharmacological treatment of acute LBP, it is fundamental to emphasize that the use of drugs should always be a second-line strategy once other non-pharmacological, non-invasive therapies have proven inadequate.” , the researchers write .
The study results were limited by several factors, including the inability to distinguish between different NSAID classes, the inability to perform a sub-analysis of the best drug or treatment protocol for a particular drug class, and the short follow-up time for the included studies, the researchers note.
More research is needed to examine the effects of different drugs on LBP recurrence, they add.
However, the results support the current view that NSAIDs can be used effectively in LBP, which is supported by the large number of studies and the relatively low risk of bias, the researchers conclude.
Study supports opioid alternatives
The current study addresses a common cause of patient morbidity and highlights alternatives to opioid analgesics for their treatment, said Suman Pal, MBBS, a specialist in hospital medicine at the University of New Mexico, Albuquerque, in an interview.
Pal said he wasn’t surprised by the results. “The results of the study reflect previous studies,” he said. “However, the lack of benefit of paracetamol alone must be emphasized as important for clinical practice.”
A key message for clinicians is the role of NSAIDs in LBP, Pal said Medscape. “NSAIDs, either alone or in combination with acetaminophen or myorelaxants, may be an effective therapy for selected patients with acute LBP.” “However, more research is needed to better identify which patients would benefit most from this approach,” he said.
Other research needs include more evidence to better understand the appropriate duration of therapy given the potential for side effects with chronic NSAID use, Pal said.
The study received no third-party funding. The researchers and Pal have not disclosed any relevant financial relationships.
J Orthop res. Published online February 22, 2023. Full text
Heidi Splete is a freelance medical journalist with 20 years of experience.
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