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NSAIDs
no better than other Over-the Counter drugs
for low back pain
Newswise — When low back pain strikes, many
people turn to non-steroidal
anti-inflammatory drugs (NSAIDs), like
naproxen and ibuprofen, or their newer COX-2
inhibitor cousin Celebrex. However, these
drugs work no better than old faithful
acetaminophen (Tylenol), according to a new
review of studies.
Review data “support guidelines for the
management of low back pain in primary care
that recommend NSAIDs as a treatment option
after paracetamol has been tried, since
there are fewer side effects with
paracetamol,” said lead reviewer Pepijn
Roelofs. Paracetamol is the European version
of Tylenol.
The researchers examined 65 studies, covering
more than 11,000 low back pain sufferers.
They concluded that NSAIDs are “slightly
effective” for short-term symptomatic
relief, allowing a return to normal activity
in patients with acute and chronic low back
pain without sciatica.
The review appears in the latest issue of The Cochrane
Library, a publication of The Cochrane
Collaboration, an international organization
that evaluates medical research. Systematic
reviews draw evidence-based conclusions
about medical practice after considering
both the content and quality of existing
medical trials on a topic.
The authors cautioned doctors that while NSAIDs
are appropriate for short-term use,
improvements are small and it is unclear
whether they work better than simple
analgesics or other drugs. No kind of NSAID
jumped out as any more effective than others
are, either, in the studies reviewed.
Moreover, the data showed that NSAIDs were not
superior to acetaminophen.
“Currently, the long-term use of NSAIDs is
controversial because of cardiovascular
adverse effects in patients with
cardiovascular risk factors, such as
previous angina pectoris, heart failure and
myocardial infarction,” said Roelofs, a
doctoral student at the Erasmus University
Medical Centre in Rotterdam.
The researchers also looked at studies on the
narcotics and muscle relaxants, finding that
NSAIDs did not bring more relief, but did
have fewer side effects.
NSAIDs have both painkilling and
inflammation-quelling properties, but they
can cause stomach upset or even ulcers.
COX-2 inhibitor class drugs can result in
fewer stomach problems, but the makers of
the COX-2 inhibitor Vioxx pulled the drug
from the market in 2004 after several
reports of cardiovascular problems related
to its use.
The review found that NSAIDs had more side
effects than placebos. However, COX-2 drugs
had fewer gastric side effects than other
NSAIDs.
The researchers looked at “non-specific” low back
pain; that is, pain not resulting from
arthritis or sciatica.
“There is conflicting evidence,” the researchers
said, “that NSAIDs are more effective than
simple analgesics and bed rest, and moderate
evidence that NSAIDS are not more effective
than other drugs, physiotherapy or spinal
manipulation for low back pain.”
“It varies from individual to individual,” said
Jon Levine, M.D., a professor of medicine at
University of California San Francisco who
was not affiliated with the review. “If one
NSAID does not work, you can try another.
This is often a very empirical situation. If
it takes care of the pain, wouldn’t you take
it?”
Pain relievers also come in combination or
physicians prescribe more than one at a
time, Levine said.
The Cochrane Collaboration is an international
nonprofit, independent organization that
produces and disseminates systematic reviews
of health care interventions and promotes
the search for evidence in the form of
clinical trials and other studies of
interventions. Visithttp://www.cochrane.org for
more information.
Roelofs PDDM, et al. Non-steroidal
anti-inflammatory drugs for low-back pain.
Cochrane Database of Systematic Reviews
2008, Issue 1.
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