Efficacy and safety of pain relievers in treating back pain ‘unclear’: study

Despite the continued popularity of drugs for treating back pain, considerable uncertainty remains about their overall impact on pain relief and safety, new research reveals. rice field.

In a paper published today, british medical journalUNSW Sydney, a researcher at Neuroscience Research Australia (Neuro) and Brunel University London examined 69 different drug or analgesic combinations and compared their effectiveness in adults with acute low back pain. This study is a meta-analysis, reviewing 98 trials, making it the most comprehensive assessment of its kind to inform clinical decision-making.

Medications tested included nonsteroidal anti-inflammatory drugs, paracetamol, opioids, anticonvulsants, antidepressants, skeletal muscle relaxants, and corticosteroids. The study found that despite the continued popularity of these drugs for treating low back pain, there is considerable uncertainty about their overall impact on pain relief and safety when compared to placebo. I got

Researchers also found that some pain medications may increase the risk of adverse events and side effects such as nausea, dizziness and drowsiness.

Professor James McAuley, Director of the Center for Pain IMPACT at NeuRA and UNSW’s School of Health Sciences, He said the study recognizes the complexity of acute back pain and treatment.

“Despite more than 60 years of research, we still do not know whether pain relievers provide meaningful pain relief for people with low back pain. Until such time as they become available, we recommend a cautious approach to the management of acute low back pain with analgesics.”

Comprehensive analysis

This study analyzed 98 randomized controlled trials (involving a total of 15,134 participants) in adults with nonspecific acute low back pain published between 1964 and 2021. These included trials that directly compared an analgesic with another analgesic, placebo, or no treatment at all, and included a total of 69 different medications or combinations.

NeuRA research fellow and lead author of the study, Dr. Michael Wewege, said the research team looked at nearly 60 years of research involving more than 15,000 participants.

“Previous reviews have evaluated analgesics versus placebo, but few have compared the efficacy of these drugs as a whole. We were able to take that into account,” said Dr. Wewege.

Dr Neil O’Connell of Brunel University London said: Our findings underscore the need for larger, more rigorous trials that can truly inform better clinical decisions.”

#1 cause of failure

Back pain remains the number one cause of disability worldwide, costing the Australian healthcare system an estimated $4.8 billion each year. According to the Royal College of General Practitioners, musculoskeletal concerns are his second most common reason for seeing a GP after psychological concerns.

The majority of people who visit a doctor for non-specific acute back pain (defined as back pain lasting less than 6 weeks) are prescribed pain medication to manage their symptoms (Australian patients 61% and 48% of patients). percent in the UK).

Impact on clinicians

Back pain is one of the main reasons people visit a GP. Although clinical practice guidelines recommend advice, reassurance, encouragement of physical activity, and self-management of symptoms as first-line care, analgesics and physical therapy are second-line interventions.

“Patients should be reassured that acute low back pain is very likely to resolve on its own over time, whether or not they are taking medication.

“When analgesics are required, clinicians should take a cautious approach and, importantly, consult with patients about their specific pain experience, severity of symptoms, and individual needs and preferences. , our research shows that this decision needs to be made.”