Do anti-inflammatory drugs really improve low back pain?
Tuesday, March 21, 2017
Acute back pain is one of the most common reasons for visits to primary care physicians, second only to colds and flu. The annual prevalence of low back pain in the United States is estimated at 15 to 20 percent, and the lifetime prevalence is over 60 percent. The first episode usually occurs between 20 and 40 years of age.
Although many cases are self-limited and resolve with little intervention, 31 percent of persons with low back pain will not fully recover within six months. Recurrent back pain occurs in 25 to 62 percent of patients within one to two years, with up to 33 percent having moderate pain and 15 percent having severe pain.
Low back pain is usually nonspecific — no evidence for radicular symptoms or underlying systemic disease — and can be caused by a number of environmental and personal factors. Other risk factors include stress, anxiety, depression, job dissatisfaction, and low levels of social support in the workplace.
Studies have found the incidence of low back pain is highest in the third decade, and overall prevalence increases with age until the 60-65 year age group and then gradually declines. Low back pain has an enormous impact on individuals, families, communities, governments and businesses throughout the world.
Low back pain is often treated with over-the-counter medications — such as nonsteroidal anti-inflammatory drugs (NSAIDs) — but new research has shown that these commonly recommended OTC medications are ineffective and expose patients to side effects.
Researchers at The George Institute of Global Health in Australia performed a systematic review with meta-analysis to determine the efficacy and safety of NSAIDs for spinal pain. They searched MEDLINE, EMBASE, CINAHL, CENTRAL and LILACS for randomized controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain.
Reviewers extracted data, assessed risk of bias and evaluated the quality of evidence using the Grade of Recommendations Assessment, Development and Evaluation approach. A between-group difference of 10 points (on a 0–100 scale) was used for pain and disability as the smallest worthwhile effect as well as to calculate numbers needed to treat. Random-effects models were used to calculate mean differences or risk ratios with 95 percent CIs.
The study included 35 randomized placebo-controlled trials involving more than 6,000 people. NSAIDs reduced pain and disability but provided clinically unimportant effects over placebo. Six participants needed to be treated with NSAIDs, rather than placebo, for one additional participant to achieve clinically important pain reduction.
When looking at different types of spinal pain, outcomes or time points, the researchers noted that the pooled treatment effects were found to be marginally above the threshold for clinical importance in only three of 14 analyses. The study also revealed that participants taking NSAIDs were 2.6 times more likely to experience gastrointestinal problems such as stomach ulcers and bleeding.
Low back pain has an enormous impact on individuals, and anti-inflammatory drugs only provide short-term pain relief of little clinical significance. This study suggests the need for new therapies to treat back pain. According to Professor Manuela Ferreira, lead author, a stronger focus should be placed on preventing pain in the first place, suggesting education and exercise programs.
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