A BMJ review reveals the absence of evidence that is high-confidence regarding the efficacy and safety of painkillers commonly used to treat temporary low back pain. Researchers recommend caution when taking analgesics until better quality studies are made available. The review was comprehensive and included more than 98 controlled, randomized trials that had low or low confidence evidence of reduced intensity of pain and a higher incidence of adverse events.
Patients and doctors are advised to adopt an equivocal approach to the treatment of analgesics.
In spite of nearly 60 years of study and study, there’s an absence of high-quality evidence regarding the effectiveness and safety of widely prescribed painkillers (analgesics) for brief episodes of low back discomfort, as per an examination of research released in the BMJ.
Researchers say that, until superior-quality studies that compare analgesics and other medications are completed, “clinicians and patients are advised to take a more cautious approach when it comes to treating acute, lower back pain by using analgesic drugs.”
Analgesics, such as paracetamol codeine, and ibuprofen are frequently utilized to treat acute and not-specific lower back pain, which is defined as pain that lasts under six weeks. However, evidence of their efficacy in comparison to other medications is scarce.
To address this knowledge gap Researchers scoured the scientific databases to find randomized controlled trials that compare analgesic drugs with other analgesic, placebo or no treatment for patients who had acute, non-specific back pain. back pain.
From a first number of relevant studies, they included the 98 randomized controlled trials that were from 1964 to 2021 for their study. They involved 15,134 people aged 18 or over, and 69 various medications or combinations.
The study included non-steroidal anti-inflammatory medications including paracetamol and opioids, anti-convulsant medications, muscle relaxants and corticosteroids. The researchers evaluated their potential bias by using a well-tested risk assessment tool.
The most important measures were the low back pain intensity at final stage of the treatment (on the scale of 0-100 points) as well as safety (number of participants who had reported any adverse events throughout treatment). The average intensity of pain among participants at the beginning the trial for each was 65 of.
The study found the low or low conviction in the proof of decreased pain intensity (around 25 %) after treatment with the muscle relaxant tolperisone and anti-inflammatory drug aceclofenac and the muscle relaxant tizanidine and the drug that prevents convulsions, pregabalin in comparison to placebo.
A low level of confidence was found in the data for significant reductions in the intensity of pain (around 20 points) for four drugs including muscles relaxant, thiocolchicoside, and the ketoprofen, a drug to combat inflammation, and modest diminutions (10-20 point) for seven drugs which include anti-inflammatory drugs such as such as ketorolac, etoricoxib and aceclofe and smaller decreases (5-10 percentage points) for three drugs, such as paracetamol and ibuprofen.
Very low or very low confidence evidence suggests that there is no difference in the effects of many of these drugs.
The study found moderate to low-confidence evidence of increased adverse reactions, such as nausea dizziness, vomiting, headache and dizziness using paracetamol, tramadol, baclofen with sustained release, and paracetamol with tramadol, compared to placebo. Low to moderate confidence evidence also suggested that these drugs may increase the risk of adverse events when compared with other drugs.
The study also provided similar moderate to low-confidence evidence for secondary outcomes, such as serious adverse events and the decision to withdraw from treatment, in addition to an analysis of the secondary effects of different classes of medication.
This review was comprehensive of the literature search. However, the authors acknowledge that the majority of studied included had issues related to bias risk that along with other limitations might have affected the results.
“Our review of analgesics for acute low back pain showed a great deal of uncertainties regarding the effects of the intensity of pain and security,” they write. They advise that doctors and patients “are advised to adopt an equivocal approach to the use of analgesic medications.”
There is no need for further reviews until studies of high-quality are published and they are a boost.
Referred to as “Comparative efficacy and security of analgesics for adults suffering from acute, not-specific lower back pain A systematic review and a Network meta-analysis” written by Michael A. Wewege Matthew K Bagg, Matthew D Jones, Michael C Ferraro, Aidan G Cashin, Rodrigo RN Rizzo, Hayley B Leake Amanda D Hagstrom, Saurab Sharma, Andrew J McLachlan, Christopher G Maher, Richard Day, Benedict M Wand, Neil E O’Connell, Adriani Nikolakopolou, Siobhan Schbrun, Sylvia M Gustin and James H McAuley, 22 March 2023, BMJ.
DOI: 10.1136/bmj-2022-072962
Financial Support: University of New South Wales
