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Evidence on the efficacy of analgesics for acute low back pain remains limited

Evidence on the efficacy of analgesics for acute low back pain remains limited


March 24, 2023

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Wewege and colleagues report that this study received project funding from the University of New South Wales.

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Important points:

  • Low-certainty evidence suggests that some analgesic treatments may be better at reducing pain than others.
  • Researchers urged doctors to exercise caution when treating patients with pain medications.

After reviewing data from nearly 100 randomized controlled trials, researchers reported that there was “substantial uncertainty” regarding the safety and efficacy of analgesics for acute nonspecific low back pain.


Michael A. Wevege PhD, Healio, a research fellow at Neuroscience Research Australia, said the research was prompted by acute low back pain, one of the most important questions is “What is the best drug to use?” “

“We wanted to compare the drugs against each other because this is information that patients and doctors want to know, but previous studies have mostly focused on comparing drugs to placebo.

Wewege and colleagues conducted a systematic review and network meta-analysis using data from 98 randomized controlled trials involving 15,134 participants.

The trial analyzed 69 analgesics or combinations, including NSAIDs, paracetamol, opioids, anticonvulsants, skeletal muscle relaxants, and corticosteroids, and compared them with other analgesics, placebo, or no treatment.

Wewege and colleagues examined differences in back pain intensity after treatment. This was based on a scale of 0 to 100 points.

Overall, “no significant differences were found between all drugs that significantly reduced pain intensity compared to placebo,” the researchers wrote.

The quality of the evidence for significant pain relief was low with tolperisone (mean difference) [MD] = -26.1; 95% CI, -34 to -18.2) and pregabalin (MD = -24.7; 95% CI, -34.6 to -14.7) and very low with aceclofenac plus tizanidine (MD = -26.1; 95 % CI, -38.5 to -13.6). These drugs may be associated with the greatest reduction in pain intensity compared to placebo, according to the researchers.

Wewege et al. also found that compared to placebo, increased adverse events during treatment may be associated with:

  • Tramadol (RR = 2.6; 95% CI, 1.5-4.5);
  • Paracetamol + extended-release tramadol (RR = 2.4; 95% CI, 1.5-3.8); and
  • Paracetamol + tramadol (RR = 2.1; 95% CI, 1.3-3.4).

There was moderate-confidence evidence for all three drugs.

Wewege and colleagues report that baclofen (RR = 2.3; 95% CI, 1.5-3.4) may further increase the risk of adverse events compared to placebo, although this is less reliable.

With limited findings on the impact of treatment on primary outcomes, Wewege said, “We urge physicians to prioritize safety and exercise caution when prescribing medications for acute back pain.”

“Although most drugs appear to make little difference in pain relief, there is moderate confidence that some may increase the risk of side effects.” It may provide pain relief, but more research is needed to confirm.”

Since most patients recover from acute low back pain within two to three weeks, Wewege recommends, “Initially, try to self-manage the pain with heat packs or massage and then return to your daily activities at a comfortable pace.” I’m here.

“Patients should always consult a medical professional for individualized advice. About treatment optionsmay contain drugs,” he said.





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