How Effective Are NSAIDs for Spinal Pain?

New research from The George Institute for Global Health concluded that common nonsteroidal anti-inflammatory drugs (NSAIDs) showed little benefit for spinal pain compared to placebo. Full findings from the study are published in the Annals of the Rheumatic Diseases. 

Acetaminophen has been shown to be ineffective for back pain but the consensus on NSAIDs for this condition is not definite. Clinical guidelines currently recommend NSAIDs as second-line analgesics after acetaminophen; opioids are recommended as third-line. Researchers performed a systematic review with meta-analysis to assess the efficacy and safety of NSAIDs for spinal pain.  

Randomized controlled trials that compared the safety and efficacy of NSAIDs with placebo for spinal pain were included in the analysis. The quality of evidence was evaluated using the Grade of Recommendations Assessment, Development and Evaluation approach. Also, a between-group difference of 10 points was used for pain and disability as the smallest worthwhile effect. A total of 35 randomized placebo-controlled trials were included. 

The data showed NSAIDs reduced pain and disability but the effects vs. placebo were clinically unimportant. Specifically, six patients needed to be treated with NSAIDs vs. placebo for one additional patient to achieve clinically important pain reduction. Only three of the 14 analyses demonstrated that pooled treatment effects were marginally above the threshold for clinical importance when examining various types of spinal pain, outcomes or time points. 

Moreover, use of NSAIDs increased the risk of gastrointestinal reactions by 2.5-fold (95% CI: 1.2–5.2) though the median duration of studied trials was seven days.

Study authors called for an “urgent need to develop new drug therapies for this condition,” as there are no simple pain relievers that provide clinically important effects for spinal pain compared to placebo. 

For more information visit ar.bmj.com.