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NSAIDs have ‘clinically unimportant’ effect on back pain

NSAIDs have little more effect than placebo in the treatment of back pain and may do more harm than good, researchers have claimed.

The team, from the University of Sydney, looked at the results of 35 randomised controlled trials comparing the efficacy of NSAIDs with placebo for treating back pain, using data from over 6,000 patients.

The researchers reported that NSAIDs reduced pain in the short term, but that overall the effect was not clinically important due to the small magnitude of difference when compared with placebo.

They calculated that six patients would need to be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term – while patients taking NSAIDs were 2.5 times more likely to suffer an adverse gastrointestinal event than those taking placebo.

The authors noted that their findings clash with current guidelines, including recently updated NICE guidance which made NSAIDs the first-line analgesic option for low back pain after ruling out use of paracetamol on its own

The team concluded: ‘In summary, compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short term.

'When this result is taken together with those from recent reviews on paracetamol and opioids, it is now clear that the three most widely used, and guideline-recommended medicines for spinal pain do not provide clinically important effects over placebo.

‘There is an urgent need to develop new analgesics for spinal pain.’

Lead author Professor Manuela Ferreira, senior research fellow at the George Institute for Global Health at the University of Sydney, commented: ‘Our results show anti-inflammatory drugs actually 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.’

He added: ‘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.’

Ann Rheum Dis 2017; available online 2 February

 

 

Readers' comments (6)

  • Instead of everyone falling over themselves to say what we can't use, how about what we CAN use?

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  • Some patients with back pain only need short-term relief due to their particular circumstances and hence NSAIDS are not without some merits. Its a pity one cannot easily perform a randomised control trial on the common sense of investigators such as GPwSIs (or Professors, either term will sonn be interchangeable) who involve themselves in such activities.

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  • Over the years I've realised that GPs probably only see a subset of patients with back pain.

    Even individuals with appreciable root syndromes will often have discovered that their problems are episodic and unlikely to be significantly helped by the doctor.

    GPs are faced with patients who either have unusually severe problems (and this should make us cautious) or perhaps have relatively poor coping strategies (and this should also make us cautious!).

    The longer I spent in the consulting room - the more I have felt that back pain is one of the most complex conditions that we see.

    If the message is that oral therapies (like most other therapies) only work for 'a few of the patients some of the time' - then it confirms clinical experience.

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  • When I take them they work and when you get to 60 you will find a judicious dose of ibuprofen before playing golf works wonders. This by the way is a case report and as such is evidence.

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  • Just Your Average Joe

    I would like to see the authors of such garbage - sit in the real world clinics with real patients and spread their cup of tea and a hug approach to back pain, and watch while the complaints and referrals fill their appraisal folders - for being useless, uncaring and patronising.

    Until they actually tell us what works successfully to replace what they feel is substandard - this research belongs in the bin.

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  • @04 Feb 2017 12:16pm
    Following a spinal injury 12 years, I have found that Diclofenac is the only medication that relieves my intermittent back pain. Hundreds of patients also say the same.
    Why the big headlines then?
    The answer is in the authors' conclusion: "There is an urgent need to develop new analgesics for spinal pain."
    Don't be surprised folk if this magic pill is around the corner, for 10 times the price of Ibuprofen and 20 times the price of Aspirin.
    I've lost count how many times I've seen this scenario.

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