An analysis of existing studies has revealed that, despite nearly 60 years of research, no definitive proof exists for the efficacy and safety of painkillers known as analgesics often prescribed to treat temporary low back pain episodes.
Researchers assert that until more studies with higher-quality comparisons of analgesic medications for managing non-specific acute low back pain can be completed, patients and clinicians should exercise caution when prescribing such medication for managing non-specific acute low back pain.
Analgesic medications like codeine, ibuprofen and paracetamol are widely prescribed to manage nonspecific acute low back pain for which there is evidence for less than 6 weeks; however, their efficacy remains questionable.
To investigate further, researchers scoured scientific databases in search of randomized controlled studies that compared analgesic medications with alternate analgesics or no treatment at all, or even a placebo for individuals reporting non-specific acute low back pain.
Analysis was performed on 98 randomized controlled studies conducted from 1964-2021 and involved 15,134 people 18 years or older taking 69 different medications or combinations.
Studies of opioids, paracetamol, NSAIDs, anticonvulsant medications, corticosteroids and muscle relaxants were evaluated using a validated risk tool in order to assess potential bias.
Primary measurements included intensity of low back pain on a scale from 0 to 100, when treatment ended, as well as safety, which was assessed through counting any adverse events during therapy sessions. At the start of each study, average pain intensity averaged 65/100.
Evidence of decreased pain intensity after treatment with anti-inflammatory medication Aceclofenac and muscle relaxant Tolperisone as well as pregabalin and Tizanidine was observed, in comparison with placebo.
Evidence of very low confidence of around 20 points was observed for pain intensity reductions from four medications – ketoprofen and muscle relaxant thiocolchicoside being among them – at 20 points reduction, moderate reductions of 10-20 points for 7 others including ketorolac, etoricoxib and aceclofenac while small reductions between 5-10 points occurred for three others like paracetamol and ibuprofen.
Evidence of low or very low confidence indicated no discernible difference in effects between any of these drugs.
Evidence of moderate to very low confidence was identified for an increase in adverse events such as headache, dizziness, drowsiness, vomiting and nausea associated with paracetamol, tramadol plus sustained-release baclofen and tramadol/paracetamol combinations compared with placebo. Furthermore, moderate-to-low confidence indicated these drugs may increase risk for adverse events when compared to other medications.
Similar evidence of moderate to low confidence was also discovered for other secondary results, such as serious adverse events and treatment discontinuation, as well as secondary analyses of classes of medication.
This comprehensive review of analgesic medications used to treat non-specific acute low back pain revealed significant assurance regarding safety and efficacy for pain intensity. Therefore, researchers advise individuals and clinicians alike to exercise extreme caution when prescribing analgesics.
