Study Finds Uncertain Effectiveness of Common Medications for Low Back Pain Relief What are the main findings?

Response: We found considerable uncertainty around the effects of analgesic medicines on pain intensity, with our confidence in most effects being low or very low. This means we are not sure about how effective these medicines are compared to placebo, nor are we sure about whether any medicines are better than any others. We have slightly more confidence that some medicines (like tramadol and baclofen) may increase the risk of common adverse events like nausea, drowsiness, and dizziness. What should readers take away from your report?

Response: We urge physicians to use caution when prescribing medicines for acute non-specific low back pain, prioritising safety. Given that most people will recover from acute low back pain within two to three weeks, we recommend that patients initially try self-managing their pain with a heat pack or massage and returning to daily activities at a comfortable pace. Patients should always speak to their health professional for individualised advice on their treatment options, which may include medicines. What recommendations do you have for future research as a result of this study?

Response: 90% of trials had concerns about risk of bias, a key reason for the low confidence in the results of our study. There is an urgent need for high-quality trials. We have conducted some additional research on the high-quality trials in our study and found that a five day course of oral ketorolac appears to be a promising treatment. We are now applying for research funding to conduct a rigorous placebo-controlled trial of ketorolac. Is there anything else you would like to add? Any disclosures?

Response: We look forward to updating our study with the results from high-quality trials that are nearing completion. Our study received project support from the University of New South Wales. Relevant author disclosures can be found in the article.


Wewege M A, Bagg M K, Jones M D, Ferraro M C, Cashin A G, Rizzo R R et al. Comparative effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain: systematic review and network meta-analysis BMJ 2023; 380 :e072962 doi:10.1136/bmj-2022-072962

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Last Updated on March 28, 2023 by