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Meta-Analysis
. 2008 Jan 23;2008(1):CD000396.
doi: 10.1002/14651858.CD000396.pub3.

Non-steroidal anti-inflammatory drugs for low back pain

P D D M Roelofs  1 , R A Deyo, B W Koes, R J P M Scholten, M W van Tulder
Affiliations
Meta-Analysis

Non-steroidal anti-inflammatory drugs for low back pain

P D D M Roelofs et al. Cochrane Database Syst Rev. .

Abstract

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequently prescribed medications worldwide and are widely used for patients with low-back pain. Selective COX-2 inhibitors are currently available and used for patients with low-back pain.

Objectives: The objective was to assess the effects of NSAIDs and COX-2 inhibitors in the treatment of non-specific low-back pain and to assess which type of NSAID is most effective.

Search strategy: We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials up to and including June 2007 if reported in English, Dutch or German. We also screened references given in relevant reviews and identified trials.

Selection criteria: Randomised trials and double-blind controlled trials of NSAIDs in non-specific low-back pain with or without sciatica were included.

Data collection and analysis: Two review authors independently extracted data and assessed methodological quality. All studies were also assessed on clinical relevance, from which no further interpretations or conclusions were drawn. If data were considered clinically homogeneous, a meta-analysis was performed. If data were lacking for clinically homogeneous trials, a qualitative analysis was performed using a rating system with four levels of evidence (strong, moderate, limited, no evidence).

Main results: In total, 65 trials (total number of patients = 11,237) were included in this review. Twenty-eight trials (42%) were considered high quality. Statistically significant effects were found in favour of NSAIDs compared to placebo, but at the cost of statistically significant more side effects. There is moderate evidence that NSAIDs are not more effective than paracetamol for acute low-back pain, but paracetamol had fewer side effects. There is moderate evidence that NSAIDs are not more effective than other drugs for acute low-back pain. There is strong evidence that various types of NSAIDs, including COX-2 NSAIDs, are equally effective for acute low-back pain. COX-2 NSAIDs had statistically significantly fewer side-effects than traditional NSAIDs.

Authors' conclusions: The evidence from the 65 trials included in this review suggests that NSAIDs are effective for short-term symptomatic relief in patients with acute and chronic low-back pain without sciatica. However, effect sizes are small. Furthermore, there does not seem to be a specific type of NSAID which is clearly more effective than others. The selective COX-2 inhibitors showed fewer side effects compared to traditional NSAIDs in the RCTs included in this review. However, recent studies have shown that COX-2 inhibitors are associated with increased cardiovascular risks in specific patient populations.

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Conflict of interest statement

One of the authors (Maurits van Tulder) is co‐ordinating editor and one of the authors (Rick Deyo) is an editor with the Cochrane Back Review Group. Editors are required to conduct at least one Cochrane review. This requirement ensures that editors are aware of the processes and commitment needed to conduct reviews. This involvement does not seem to be a source of conflict of interest in the Cochrane Back Review Group. Any editor who is a review author is excluded from editorial decisions on the review in which they are contributors.

Figures

1.1
1.1. Analysis
Comparison 1 NSAIDs versus placebo for acute LBP, Outcome 1 Change in Pain Intensity from baseline on 100mmVAS. Follow‐up <=3 weeks..
1.2
1.2. Analysis
Comparison 1 NSAIDs versus placebo for acute LBP, Outcome 2 Proportion of patients experiencing global improvement. Follow‐up <=3 weeks..
1.3
1.3. Analysis
Comparison 1 NSAIDs versus placebo for acute LBP, Outcome 3 Proportion of patients experiencing side effects. Follow‐up <=3 weeks..
1.4
1.4. Analysis
Comparison 1 NSAIDs versus placebo for acute LBP, Outcome 4 Additional analgesic use. Follow‐up <=3 weeks..
1.5
1.5. Analysis
Comparison 1 NSAIDs versus placebo for acute LBP, Outcome 5 Change in Pain Intensity from baseline on 100mmVAS..
2.1
2.1. Analysis
Comparison 2 NSAIDs versus placebo for chronic LBP, Outcome 1 Change in Pain Intensity from baseline on 100mm VAS. Follow up <=12 weeks..
2.2
2.2. Analysis
Comparison 2 NSAIDs versus placebo for chronic LBP, Outcome 2 Proportion of patients experiencing side effects. Follow up <=12 weeks..
3.1
3.1. Analysis
Comparison 3 NSAIDs versus paracetamol, Outcome 1 Pain Intensity on various scales. Follow‐up <=3 weeks..
3.2
3.2. Analysis
Comparison 3 NSAIDs versus paracetamol, Outcome 2 Proportion of patients experiencing global improvement. Follow‐up <=3 weeks..
3.3
3.3. Analysis
Comparison 3 NSAIDs versus paracetamol, Outcome 3 Proportion of patients experiencing side effects. Follow‐up <=3 weeks..
4.1
4.1. Analysis
Comparison 4 NSAIDs versus other drug treatment, Outcome 1 Proportion of patients experiencing global improvement. Follow‐up <=3 weeks..
4.2
4.2. Analysis
Comparison 4 NSAIDs versus other drug treatment, Outcome 2 Proportion of patients experiencing side effects. Follow‐up <=3 weeks..
5.1
5.1. Analysis
Comparison 5 NSAIDs selective COX‐2 inhibition versus non selective, Outcome 1 Change in Pain Intensity from baseline on 100mmVAS..
5.2
5.2. Analysis
Comparison 5 NSAIDs selective COX‐2 inhibition versus non selective, Outcome 2 Proportion of patients experiencing side effects.
5.3
5.3. Analysis
Comparison 5 NSAIDs selective COX‐2 inhibition versus non selective, Outcome 3 Proportion of patients experiencing gastrointestinal side effects.
5.4
5.4. Analysis
Comparison 5 NSAIDs selective COX‐2 inhibition versus non selective, Outcome 4 Proportion of gastrointestinal side effects.
See this image and copyright information in PMC

Update of

References

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References to studies excluded from this review

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References to studies awaiting assessment

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References to ongoing studies

ACTRN012605000036617 {unpublished data only}
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