More effective vs placebo? Less effective than opioids? Equally as potent as APAP? What’s true and what false about NSAIDs?
A recent literature review found only 14 RCTs (1982-2013) examining the use of NSAIDs for CLBP.
Opioids are often assumed to be the most effective analgesics, but there is no evidence that they are more effective than NSAIDs for CLBP.
When NSAIDs are compared to placebo
for CLBP, the former are associated with greater reduction in pain that is statistically significant.
Studies have shown NSAIDs to be more effective than placebo for CLBP relief; but after correction for study bias, the difference was not statistically significant.
There is little research on NSAID impact on functional level in CLBP; where NSAIDs have shown greater benefit vs placebo, quality of evidence is considered low.
Evidence is insufficient to determine whether one NSAID is more effective than another for CLBP.
There are no predictive factors
for determining which NSAID will be most effective for a patient with CLBP other than previous positive response to a specific agent.
No predictive factors have been identified that would indicate which NSAID is likely to be most beneficial for an individual patient.
Recommendations are that NSAID use for CLBP be limited to the shortest duration possible, but no optimal duration is known.
Studies that compare efficacy of NSAIDs vs APAP for CLBP are few and the findings do not support the superiority of NSAIDs over acetaminophen.
It has yet to be established
whether combining an NSAID with an analgesic from another class is likely to provide more benefit for CLBP management than the NSAID alone.
Guidelines for treatment of chronic low back pain (CLBP) recommend remaining active and exercising, with the use of analgesics if necessary. Nonsteroidal anti-inflammatory drugs (NSAIDs), both over the counter and by prescription, are one of the most frequently used agents in low back pain management.How effective are they?Try these 10 True or False statements based on a recent update to a Cochrane review of NSAID use for chronic back pain. The truths may surprise you.Â Â