A systematic review on the effectiveness of pharmacological interventions for chronic non-specific low-back pain

Abstract

The objective of this review was to determine the effectiveness of pharmacological interventions [i.e., non-steroid anti-inflammatory drugs (NSAIDs), muscle relaxants, antidepressants, and opioids] for non-specific chronic low-back pain (LBP). Existing Cochrane reviews for the four interventions were screened for studies fulfilling the inclusion criteria. Then, the literature searches were updated. Only randomized controlled trials on adults (≥18 years) with chronic (≥12 weeks) non-specific LBP and evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery, or return to work) were included. The GRADE approach was used to determine the quality of evidence. A total of 17 randomized controlled trials was included: NSAIDs (n = 4), antidepressants (n = 5), and opioids (n = 8). No studies were found for muscle relaxants; 14 studies had a low risk of bias. The studies only reported effects on the short term (<3 months). The overall quality of the evidence was low. NSAIDs and opioids seem to lead to a somewhat higher relief in pain on the short term, as compared to placebo, in patients with non-specific chronic low back pain; opioids seem to have a small effect in improving function for a selection of patients who responded with an exacerbation of their symptoms after stopping their medication. However, both types of medication show more adverse effects than placebo. There seems to be no difference in effect between antidepressants and placebo in patients with non-specific chronic LBP.Electronic supplementary materialThe online version of this article (doi:10.1007/s00586-010-1541-4) contains supplementary material, which is available to authorized users.

Trends over time in the size and quality of randomised controlled trials of interventions for chronic low-back pain

“…The largest number of trials came from the review of physical and rehabilitation interventions (n = 83) [12], followed by complementary and alternative therapies (n = 30) [13], injection and denervation procedures (n = 27) [15], and pharmacological interventions (n = 17) [14]. The earliest year of publication for an included trial was 1980, with an increase in the number of RCTs per year until 2008, which is the last date that literature was searched.…”

“…Four systematic reviews, commissioned by the Dutch Health Care Insurance Council (CVZ), were performed to evaluate current evidence for physical and rehabilitation interventions [12], complementary and alternative therapies [13], pharmacological interventions [14], and injection and denervation procedures [15] in patients with chronic LBP. The current study is based on the trials that were included in this series of systematic reviews.…”

The Recent Trend in Diagnosis and Treatment of Chronic Low Back Pain

“…There is little evidence, however, supporting its effectiveness for chronic low back pain 45) . Opioid use in Japan has recently started, but it has not been related to improvement in disability or dysfunction 46) .…”

Causes, Diagnosis and Treatment of Unspecific Lumbalgia: Myths and Reality

“…Во многих случаях используют трици-клические антидепрессанты, однако вопрос об их эффек-тивности остается дискуссионным [25].…”