Nonsteroidal Anti-Inflammatory Drugs for Back Pain and Sciatica: A Meta-Analysis

[Argirios Argiriou]

Journal Watch.
August 10, 2017

Nonsteroidal Anti-Inflammatory Drugs for Back Pain and Sciatica: A Meta-Analysis


Allan S. Brett, MD Reviewing Machado GC et al., Ann Rheum Dis 2017 Jul 76:1269
Only a small proportion of patients derived benefit from these drugs, and the benefit was modest.

Although nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed commonly for patients with low back and neck pain, randomized trials have not shown dramatic benefits. In this meta-analysis, researchers identified 35 randomized, placebo-controlled trials of NSAID therapy for acute or chronic low back pain or sciatica (33 trials) or neck pain (only 2 trials). Median study duration was 7 days; no study extended beyond 3 months.

On 100-point pain scales, mean differences in pain relief between NSAIDs and placebo were 9.2 points for studies lasting less than 2 weeks and 7.7 points for studies lasting 2 weeks to 3 months. Outcomes were in this general range for both acute and chronic pain and for both nonsciatic and sciatic pain. About six patients had to be treated to alleviate pain in one patient (based on the assumption that a clinically meaningful difference is ≥10 points). For disability, mean differences between NSAIDs and placebo were also less than 10 points on 100-point scales.

Comment

These results confirm my clinical experience: Only a small proportion of patients with back pain or sciatica perceive benefit from NSAIDs, and some of the perceived benefit reflects placebo effects or the tendency for these conditions to fluctuate or improve. Moreover, in recent meta-analyses, acetaminophen was ineffective for low back pain (NEJM JW Gen Med May 1 2015 and BMJ 2015; 350:h1225) and opioids were only marginally effective (NEJM JW Gen Med Jul 15 2016 and JAMA Intern Med 2016; 176:958). Taken together, these meta-analyses paint a pessimistic picture of drug treatment for back pain.

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