A comprehensive evaluation of the safety and efficacy of analgesic medicines for acute, non-specific low back pain found that considerable uncertainty remains around their overall impact on pain relief and safety.

The study, published in respected medical journal BMJ, looked at 69 different medicines or combinations of analgesic medicines.

These included non-steroidal anti-inflammatory drugs, paracetamol, opioids, anticonvulsants, antidepressants, skeletal muscle relaxants and corticosteroids to compare their effectiveness for adults with acute low back pain.

The review concluded that clinicians should take a cautious approach to the use of analgesic medicines and make treatment decisions in consultation with patients to address their specific causes of low back pain, severity of symptoms and individual preferences.

Dr Matthew Bagg, Research Fellow at Curtin University, Perron Institute and NeuRA, had a leading role in setting up the study and supervised the process.

“Using meta-analysis, this has been the most comprehensive evaluation of its kind to inform clinical decision making,” Dr Bagg said.

“It’s encouraging that these study results indicate the kind of trials that are necessary. At the completion of each new trial, we’ll systematically update the overall evidence base.”

Senior author Professor James McAuley, Director for the Centre for Pain IMPACT at NeuRA, and Professor at UNSW’s School of Health Sciences, said the study recognised the complexities in acute low back pain and treatment.

“While analgesics can provide effective pain relief for some patients, their impact on individual patients can vary greatly. This study shows we do not yet know the most effective and safe medicines overall.

“It is important for clinicians to take into account patients’ medical histories and tolerance for side effects to determine the most effective and safe treatment.”

Back pain continues to be the number one cause of disability worldwide. According to the Royal College of General Practitioners, musculoskeletal concerns are the second-most common reason for GP visits, after psychological concerns.

Most people who visit their doctor for acute non-specific low back pain, defined as low back pain lasting fewer than six weeks, are prescribed an analgesic to manage their symptoms.

The new study was conducted by researchers at Neuroscience Research Australia (NeuRA), UNSW Sydney and Brunel University London.

As well as uncertainty around the overall impact of the analgesics on pain relief and safety when compared with a placebo, it also found that some analgesic medicines could increase the risk of adverse events or side effects such as nausea, dizziness and drowsiness.

Article based on NeuRA statement.