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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




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