Low back pain (LBP) is one of the most prevalent health conditions and one of the leading causes of disability worldwide; NSAIDs are often used for the treatment of LBP. In 2008, a Cochrane Review about NSAIDs for LBP, compared with placebo or other drugs/ therapies, suggested that NSAIDs are slightly effective for short-term symptomatic relief in patients with acute and chronic low-back pain without sciatica; moreover, the new selective COX-2 inhibitors were found to have similar effects than non-selective NSAIDS, with fewer gastrointestinal side effects.  

Low back pain (LBP) is one of the most prevalent health conditions and one of the leading causes of disability worldwide; NSAIDs are often used for the treatment of LBP. In 2008, a Cochrane Review about NSAIDs for LBP, compared with placebo or other drugs/therapies, suggested that NSAIDs are slightly effective for short-term symptomatic relief in patients with acute and chronic low-back pain without sciatica; moreover, the new selective COX-2 inhibitors were found to have similar effects as non-selective NSAIDS, with fewer gastrointestinal side effects. 

A recent review by van der Goes and other authors updates the 2008 findings, focusing on NSAIDs’ effects on acute LBP. The literature search, up to January 2020, includes 32 randomized controlled trials (6 more than the previous review), with a total of 5,356 participants with acute LBP, assessing the effect of one or more types of NSAIDs compared to placebo or alternative treatments on pain, disability, global improvement, adverse events, and return to work.

According to the results of the previous Cochrane Review, NSAIDs slightly reduce disability (high-certainty evidence) and probably slightly reduce pain (moderate-certainty evidence) in acute LBP.

However, pain intensity decreases on average by 7.3 points on a 100-point scale and disability by 2 points on a 24-point disability scale in NSAIDs group compared to those using placebo: thus, the magnitude of the NSAIDs’ effect is probably too small to be clinically relevant.

There is uncertainty on the proportion of participants experiencing adverse effects between NSAIDs versus placebo and selective COX-2 inhibitor NSAIDs compared to non-selective NSAIDs because of no clear difference between group results.

Almost half of the studies were industry funded, and several trials are very old; moreover, similar outcomes were often measured in very different ways. In 2018, a preliminary core outcome measurement set, specifying tools to be included in clinical trials involving people with nonspecific LBP, was developed by an international steering committee.

Hopefully, the employment of this measurement set might increase the quality of evidence in future trials on the treatment of acute LBP.

Commented by Francesca Cecchi