Low Back Pain

TREATMENT OF LOW BACK PAIN: A REVIEW OF THE EVIDENCE WITH DR. HUTCHINSON

Medications for LBP

NSAIDS:  

2008 -- Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008.

• NSAIDs demonstrated statistically significant improvement in symptomatic treatment of acute and chronic low back pain w/o sciatica (versus placebo) but effect sizes were small
• Moderate evidence that NSAIDs are more effective than Tylenol
• No NSAID clearly more efficacious than another
• COX-2 inhibitors had fewer report side effects

2016 -- Enthoven WTM, Roelofs PDDM, Deyo RA, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database of Systematic Reviews 2016.

• Less pain & disability with NSAIDs (vs placebo), effect sizes were small.
• No difference btwn NSAID types.
• NSAIDs compared to tylenol, tramadol and pregabalin showed no differnce in effect or adverse events. 

Tylenol: 

Saragiotto BT, Machado GC, Ferreira ML, Pinheiro MB, Abdel Shaheed C, Maher C. Paracetamol for low back pain. Cochrane Database of Systematic Reviews 2016.

No benefit vs placebo for acute low back pain (high quality evidence) for pain, sleep, or quality of life

Muscle Relaxants:

Van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003.

• Muscle relaxants are more effective compared to placebo for short term relief of acute low back pain (high quality evidence)

Heat: 2006 systematic review demonstrated moderate evidence of short lived benefit 

Massage, acupuncture: No strong evidence of benefit

Spinal manipulation: May have some role for modest improvement 

Exercise and PT: Evidence is clearer for patients with chronic back pain 

No evidence: Herbals, AEDs, lidocaine patch, antidepressants 

Steroids

Acute Non-radicular LBP:  No evidence to support use of systemic steroids in acute nonspecific back pain (based on small RCTs)


Acute radicular LBP: No benefit for pain & small to no benefit for function (2017 systematic review and ACP practice guideline )

Steroid Injections

Pinto RZ, Maher CG, Ferreira ML, et al. Epidural Corticosteroid Injections in the Management of Sciatica: A Systematic Review and Meta-analysis. Ann Intern Med. 2012;157:865–877. doi: 10.7326/0003-4819-157-12-201212180-00564

• Small/short term relief of leg pain and disability for patients with sciatica (high quality evidence)

The information posted above is for educational use only by the trainees of a non-profit hospital residency program.
Compiled by Emma