An update to a 2008 Cochrane review of the effectiveness of NSAIDs such as ibuprofen on low pain was recently published, and is worth reviewing in light of on-going work to improve chronic pain treatments.
The key takeaways:
So, it appears that minor benefit (e.g. ~3%) occurs relative to placebo, but it's minor enough to question their use over any long-term period. Yet, the study is able to look at one non-pharmacological approach to lower back pain - exercise and movement - that does appear to have supporting data:
Disability improved more in participants who did exercises versus participants receiving NSAIDs, but pain scores were similar.
It's just another chance to look beyond opioids and consider whether other sets of existing, widespread and in this case usually OTC pharma tools receive a disproportionate share of use relative to benefit, and that the benefits and reduced risks of many alternative approaches remain clear. Of course, remember this review is specific to chronic lower back pain.