Clinical question
How effective are non-steroidal anti-inflammatory drugs (NSAIDs) for non-specific chronic low back pain in adults?
Bottom line
There was low quality evidence that NSAIDs were slightly better in reducing pain (3.3 points less on a 100-point scale for pain intensity) and disability (0.9 points better on a 0 to 24 scale) than placebo, but the effects were very small and possibly not clinically relevant. The studies with a low risk of bias showed no significant difference between NSAIDs and placebo. It was unclear whether NSAIDs were more effective than other drugs, and there was no evidence to show that one NSAID type was more effective than other types.
Caveat
Due to the inclusion of only randomised controlled trials, the relatively small sample sizes and the relatively short follow-up in most trials (9 days to 16 weeks), it was not possible to make firm statements about the occurrence of adverse events or the safety of NSAIDs for long-term use. Half of the included trials were supported by or included authors from pharmaceutical companies.
Context
Chronic low back pain is a common cause of pain and disability. NSAIDs are often used for treatment and are available both over the counter and on prescription in different types and chemical entities.
Cochrane Systematic Review
Enthoven WTM et al. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Reviews, 2016, Issue 2. Art. No.: CD012087.DOI: 10.1002/14651858. CD012087. This review contains 13 studies involving 4,807 participants.
Cochrane Systematic Reviews for primary care practitioners
Developed by the Cochrane Primary Care Field, New Zealand Branch of the Australasian Cochrane Centre at the Department of General Practice and Primary Health Care, University of Auckland and funded by the Ministry of Health and New Zealand Doctor. PEARLS are meant for educational use and not to guide clinical care. New Zealanders can access the Cochrane Library free via www.cochrane.org.nz
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