NSAIDs don’t work for back pain

There is an urgent need to develop clinically effective and safe drug therapies to treat back pain, say Australian researchers

A systematic review and meta-analysis conducted by The George Institute for Global Health has added NSAIDs to the pile of ineffective drugs for back pain.

Anti-inflammatories will be joining paracetamol, which the British Medical Journal, The Lancet and a Cochrane Review also ruled out as an effective treatment for back pain in 2015.

This latest study of 35 randomised placebo-controlled trials, published in the Annals of the Rheumatic Diseases, found that while NSAIDs reduced pain and disability, the effects compared with placebo were clinically unimportant.

Meanwhile, patients taking NSAIDs were 2.5 times more likely to suffer from gastrointestinal problems such as stomach ulcers and bleeding.

Lead author, Associate Professor Manuela Ferreira from the University of Sydney, says that while back pain is the leading cause of disability and is commonly managed by prescribed anti-inflammatories, the results show they only provide very limited short-term pain relief.

“They do reduce the level of pain, but only very slightly, and arguably not of any clinical significance,” says A/Prof Ferreira.

“When you factor in the side effects which are very common, it becomes clear that these drugs are not the answer to providing pain relief to the many millions of Australians who suffer from this debilitating condition every year.”

She says the study highlight an urgent need to develop new therapies to treat back pain.

Fellow author Gustavo Machado, from The George Institute and the University of Sydney’s School of Medicine, agrees.

“Millions of Australians are taking drugs that not only don’t work very well, they’re causing harm. We need treatments that will actually provide substantial relief of these people’s symptoms.

“Better still we need a stronger focus on preventing back pain in the first place. We know that education and exercise programs can substantially reduce the risk of developing low back pain.”

Most clinical guidelines currently recommend NSAIDs as the second-line analgesics after paracetamol, with opioids coming at third choice, The George Institute points out.

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