Lower Back Pain & NSAID Effectiveness

NSAIDs & Low Back Pain

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:

  • There are only a handful of randomized studies for chronic lower back pain & NSAIDs
  • Studies with low risk of bias show only minimal NSAID benefit compared with placebo  
  • There's no real evidence that NSAIDs help function -- whereas exercise clearly improves function and lowers disability
  • There's insufficient data to conclude that one NSAID is any more effective than another
  • No predictive efficacy factors or multi-drug combinations have been studied sufficiently
  • NSAIDs have not been studied enough to determine long-term risks of chronic use

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. 

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Posted by BreatheAware Blog on 02/20/18