The analgesic effect of nonsteroidal anti-inflammatory drug (NSAIDs) in chronic low back pain is minimal

SOURCE

Wendy TM Enthoven et al. (2016) Non-steroidal anti-inflammatory drugs for chronic low back pain, Cochrane Database Syst Rev 2016 10;2:CD01208.

CONTEXT

Nonsteroidal anti-inflammatory drug (NSAIDs) are commonly used as a second-line therapy after paracetamol in chronic low back pain.

CLINICAL QUESTION

What is the analgesic effect of NSAIDs in common chronic low back pain?

BOTTOM LINE

Six studies showed a significantly higher analgesic effect with NSAIDs compared to placebo in chronic low back pain (level of evidence: low). However, the authors note that since the magnitude of this difference is small, it might not be clinically meaningful. Besides, exclusion of studies with a high risk of bias obliterates this statistically significant difference. The same applies to NSAIDs effect on disability. The rate of adverse effects with NSAIDs was similar to placebo.

The efficacy of NSAIDs compared to other painkillers is unclear; however, there is no significant difference between selective and non-selective NSAIDs.

CAVEAT

The relatively short follow-up and the small sample size hinders the detection of severe and rare adverse effects.

AUTHOR INFORMATION

Yannick AUFFRET
Centre Hospitalier de Cornouaille
Quimper, France
y.auffret@ch-cornouaille.fr

Haldun AKOGLU
Marmara University Faculty of Medicine
Istanbul, Turkey
drhaldun@gmail.com