Nonopioid Medications for Management of Acute Low Back Pain: What Works Best?
Which of the 3 nonopioid analgesics most commonly used to treat acute LBP is/are most effective? A new systematic literature review offers 1 view of the data.
Acute low back pain (LBP) is among the most common health complaints in the US. It is estimated that up to 25% of the population has experienced at least 1 episode during the previous 3 months. Opioids have historically been prescribed to treat acute LBP despite a lack of evidence to support the practice; in fact, they are prescribed to almost 14% of patients with a LBP complaint.
However, prevailing concerns regarding overprescribing, supplying the illicit market, and potential for widespread abuse have led to earnest calls to reduce opioid prescribing for acute pain conditions and in some states to limitations on how long they can be prescribed.
A recent systematic review examined which common nonopioid medications have been found to be most efficacious for the management of acute LBP. The slides below offer an at-a-glance review of the study and findings.
A new systematic literature review of studies on nonopioid treatment for acute low back pain identified 18 studies with a total of 3478 patients.
Three nonopioids were of interest for treatment of acute low back pain: Muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen (APAP).
For treatment of acute LBP, NSAIDs provided the most pain relief and improvement in disability at 1 week after initiating therapy.
Muscle relaxants also improved both pain and disability at 1 week for patients with acute LBP, although they were less effective than NSAIDs.
For acute LBP, aalysis found that APAP, when used alone, was no more effective than placebo for reducing pain or disability.
NSAIDs and muscle relaxants were found in this systematic reivew to be more effective treatment for acute LBP than APAP.
Considering APAP for acute LBP: added to an NSAID, APAP appeared in this review to enhance the effect of the NSAID.
More on APAP: In treating other types of acute pain, APAP monotherapy appeared effective so adding it to an NSAID likely created synergistic effect.
Always consider drug side effects in the context of patient health status to avoid negative outcomes.
Analysis of the 18 studies left open questions regarding which agents in each class might benefit a given patients; whether treatment effect would last beyond 1 week; and, whether observed improvements in pain/function would reduce risk of chronic LBP.
