PainRelief.com: What are the main findings?
Response: According to the main findings of the present study, myorelaxants and nonsteroidal anti-inflammatory drugs were effective in reducing pain and disability in acute low back pain at approximately one week. The combination of nonsteroidal anti-inflammatory drugs and paracetamol was associated with a greater improvement than the sole administration of nonsteroidal anti-inflammatory drugs, but paracetamol alone did not promote any significant improvement in clinical outcomes. Placebo administration was not effective in reducing pain. However, it is important to consider these results in light of the several limitations of the present study. We considered different compounds administered with different protocols. Given the heterogeneity of the compounds and protocols used, the available data was not sufficient to perform a sub-analysis of the best drug or protocol to be employed within a given class. It is fundamental to highlight that this work only refers to nonspecific, acute LBP therapy. Furthermore, the follow-up was very short for all of the considered studies. This partly results from the acuity of the condition, which by definition is limited in time. However, given the high recurrence of acute low back pain, further studies will have to focus on the short-term effects of any given treatment and the possible differences in the long-term outcomes and the relapse rate.
PainRelief.com: What should readers take away from your report?
Response: When treating patients with acute low back pain, it is important to rule out possible specific causes of pain that may require specific actions or diagnostics, for example, a history of cancer or recent trauma; identification of possible red flags should always be a pillar of the assessment of acute low back pain. As the natural history of acute low back pain shows a spontaneous reduction of symptoms in most patients, the real efficacy of pharmacological management is dubious. However, placebo did not demonstrate a significant change from the baseline to the last follow-up, thus reinforcing our hypothesis that pharmacological management improves symptoms. Furthermore, a therapeutic option must be offered to those patients who do not obtain sufficient benefit from non-pharmacological management. In clinical practice, we stress that the use of drugs should always be a second-line strategy once other non-pharmacological, non-invasive therapies have proved to be inefficacy
Baroncini, A., et al. (2023) Nonopioid pharmacological management of acute low backpain: A level I of evidence systematic review. Journal of Orthopaedic Research. doi.org/10.1002/jor.25508.
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