NSAIDs for Low Back Pain – Brass Tacks Concise Review

Written by Clay Smith

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NSAIDs are an effective treatment for low back pain, though the absolute reduction in pain and disability is small.

Why does this matter?
If you live long enough, you will have back pain. 80% of people experience it at some point in life. Apart from time, what is the most effective treatment?

Back pain is a pain in the neck
This was a concise review in Annals of EM of a Cochrane meta-analysis. The meta-analysis included 9 RCTs, 2,232 patients and found that, “compared to placebo, NSAIDs may reduce pain intensity and disability, and increase the proportion of patients experiencing global improvement.”

NNT:

  • 14 for reducing pain

  • 12 for reducing disability

  • 13 global improvement

NSAIDs used in the trials included: ibuprofen, piroxicam, dipyrone, tenoxicam, and diclofenac. The review authors rated this intervention as “yellow,” meaning uncertain effectiveness. That’s because the absolute risk reduction was small and of questionable clinical significance, in their opinion.

Source
Non-steroidal anti-inflammatory drugs for acute low back pain. Acad Emerg Med. 2020 Aug 12. doi: 10.1111/acem.14111. Online ahead of print.

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