Between guidelines and clinical trials: evidence-based advice on the pharmacological management of non-specific chronic low back pain

Abstract

The pharmacological management of nonspecific chronic low back pain (NCLBP) aims to restore patients’ daily activities and improve their quality of life. The management of NCLBP is not well codified and extremely heterogeneous, and residual symptoms are common. Pharmacological management should be considered as co-adjuvant to non-pharmacological therapy, and should be guided by the symptoms reported by the patients. Depending on the individual severity of NCLPB, pharmacological management may range from nonopioid to opioid analgesics. It is important to identify patients with generalized sensory hypersensitivity, who may benefit from dedicated therapy. This article provides an evidence-based overview of the principles of pharmacological management of NCLPB.

Baduanjin exercise for chronic non-specific low back pain: protocol for a series of N-of-1 trials

“…15 At present, drug recommendations for chronic LBP are heterogeneous among different countries. 16 For example, the use of opioids is inconclusive in the Canada clinical guideline, but it is recommended in the USA clinical guideline. Non-pharmacological therapies should be considered as the first-line therapies for CNLBP.…”

“…Non-pharmacological therapies should be considered as the first-line therapies for CNLBP. 16 It is reported in some systematic reviews that exercise and physical activity are beneficial for the recovery of CNLBP. [17][18][19] According to the American College of Physicians guideline, exercise is recommended for chronic LBP.…”

Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis

“…Different physiotherapeutic regimes have been developed and investigated in this setting 22 , 23 . In particular, different forms of exercise, manual therapy, physical agent modalities, and education, or a combination of these in a multidisciplinary approach have been efficiently applied in the setting of cLBP 24 , 25 . Available guidelines also highlight a discrepancy regarding the most effective physiotherapeutic management, and clear directions in this respect are lacking 13 , 26 , 27 .…”

Ultrasound‐guided erector spinae plane block in patients with chronic lumbar facet joint pain: A prospective case‐controlled study

“…Chronic low back pain (LBP), defined as "chronic" when symptoms last more than 3 months, is one of the most frequent pain disorders and the primary cause of physical function impairment worldwide. [1][2][3] Nonpharmacological treatments like education, psychological techniques, structured physical activity programs, and manipulation are generally suggested as the firstline therapy for chronic LBP in most treatment guidelines. 3,4 Additionally, physical therapy and rehabilitation programs might be considered second-line treatments for these patients and attempt to enhance function while preventing disability.…”

“…[1][2][3] Nonpharmacological treatments like education, psychological techniques, structured physical activity programs, and manipulation are generally suggested as the firstline therapy for chronic LBP in most treatment guidelines. 3,4 Additionally, physical therapy and rehabilitation programs might be considered second-line treatments for these patients and attempt to enhance function while preventing disability. 5,6 Most guidelines encourage the use of NSAIDs and antidepressants as necessary.…”