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Reaction: meta-analysis finds lack of scientific evidence on efficacy and safety of painkillers for low back pain

A meta-analysis analysing 98 published clinical trials highlights the lack of scientific evidence on the efficacy and safety of commonly used analgesic drugs for acute low back pain (such as anti-inflammatory drugs, paracetamol and opioids, among others). The study, published in The BMJ, includes data from more than 15,000 people. It concludes that there is "considerable uncertainty" about the efficacy of these drugs in reducing the severity of non-specific acute low back pain and calls on doctors and patients to use them with caution.

22/03/2023 - 23:30 CET
Expert reactions

Lucía Hipólito - dolor lumbar EN

Lucía Hipólito

Researcher and lecturer at the faculty of Pharmacy

Science Media Centre Spain

This is a very interesting study that conducted a systematic review and meta-analysis of a total of 98 randomised controlled studies of pharmacological treatments in patients with acute low back pain. It is particularly interesting because of its design that aggregates data from more than 15,000 participants, 49% of whom were women. It concludes that the effectiveness and safety of approved treatments for the management of acute low back pain are questionable, and that studies of higher quality are needed to improve the drug treatment regimens used to treat this frequent, painful condition.  

 This conclusion is of great importance for clinical practice and reaffirms previous studies that have already shown a lack of evidence on the ability of some analgesic drugs to reduce the intensity of acute low back pain. This uncertainty really makes it complicated for primary care clinicians when it comes to making decisions on the prescription of anti-inflammatory drugs, anticonvulsants, opioids, combinations of both, paracetamol or corticoids to treat this condition. Therefore, without such evidence to support their use, prescribing [such drugs] should be limited. However, it is important to note some of the limitations of the study that the authors mention themselves, such as the selection of patients or the lack or high variety of the type of adverse effects data collected in the different studies considered for this meta-analysis. It is for this reason that the authors reaffirm the need to continue these studies, in order to improve our knowledge of the use of analgesic therapies for the treatment of pain.  

Taking into account these results, which could be extended to the Spanish population, it is necessary to promote research in this field, as the same study calls for caution when interpreting these results of efficacy and side effects.  

Although of great importance, the conclusions obtained will not yet have an impact on patients' treatment regimens. But they should focus our attention on the outcomes of analgesic use by both patients and their physicians, to avoid side effects and to implement the necessary measures, including switching, discontinuation of analgesic use or use of other non-pharmacological measures, to improve the clinical management of the patient.

Lucía Hipólito is the principal investigator of research projects funded by Spain’s Ministry of Science and Innovation, the Government Delegation for the National Drugs Plan (Ministry of Health) and the Regional Ministry of Innovation, Universities, Science and Digital Society. In addition, she co-authored a chapter of a guide for patients with chronic pain, coordinated and edited by the College of Pharmacists of Valencia, and received payment from Grünenthal Pharma for this project.

Comparative effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain: systematic review and network meta-analysis
  • Research article
  • Peer reviewed
  • Randomized
  • Clinical trial
  • Meta-analysis
Publication date

Michael A Wewege et al.

Study types:
  • Research article
  • Peer reviewed
  • Randomized
  • Clinical trial
  • Meta-analysis
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