Ibuprofen isn’t great for back pain, but it’s not useless either

Ibuprofen is only a little better than a placebo in relieving back pain, according to a study at the George Institute for Global Health in Australia.

Researchers examined 35 randomised controlled trials involving more than 6,000 patients taking non-steroidal anti-inflammatory drugs (NSAIDs).

They found that the drugs provided relief to only one in six patients, and that those using the drugs were nearly three times more likely to suffer from stomach ulcers and bleeding.

The study, published in Annals of the Rheumatic Diseases, concludes that exercise is the most effective treatment for back pain.

Recent meta-analyses found that paracetamol and opioids were also generally ineffective.

The study’s lead author, Professor Manuela Ferreira, said: ‘Back pain is the leading cause of disability worldwide and is commonly managed by prescribing medicines such as anti-inflammatories. But our results show anti-inflammatory drugs actually only provide very limited short-term pain relief.

‘They do reduce the level of pain, but only very slightly, and arguably not of any clinical significance. When you factor in the side effects, which are very common, it becomes clear that these drugs are not the answer to providing pain relief.’

Another recent review found that, for chronic back pain, yoga was just as effective as exercise.

Instant analysis
This was a meta-analysis of randomised controlled trials which, if involving high-quality papers, represents the gold standard of evidence.

Thirty-five papers were assessed, analysed and their results pooled. The majority of studies dealt with back pain, both chronic and acute. With any intervention, it is important to be aware of both short and long-term effects; follow-up in this paper was immediate term (less than two weeks) and short term (two weeks to three months).

Pain, disability and quality of life measures were assessed using validated pain scores which were then compared to each other for accurate assessment. For the purposes of this paper, a 10-point difference in reported pain scores was considered ‘clinically significant’.

In the immediate term, NSAID use was found to be effective for patients with acute and chronic lower back pain as well as sciatica, with five patients requiring treatment for one to benefit. In the short term, it appears to be relatively effective only for one in six people with chronic lower back pain.

The data was analysed in several ways in order to fully delineate the risks and benefits of treatment. Only four out of the 17 analyses found a clinically significant benefit of using NSAIDs for pain relief.

This is an important paper for several reasons. Lower back pain is a major cause of morbidity but also represents a significant health-related cause of lost productivity in the workplace. From a medical perspective, it can be challenging to adequately relieve the pain of these patients enough to allow resumption of normal activities of daily living, while minimising the side effects of treatment.

Regular NSAID use over the long term can be associated with kidney damage, and is not advisable for patients with pre-existing kidney disease, certain blood disorders and more severe forms of asthma. Any temptation to freely indulge in these over-the-counter drugs must be resisted.

However, the demise of NSAIDs as a form of pain relief for back pain, as reported in the press, has been greatly exaggerated. While they may not be as effective as we would like, they are still superior to a placebo, at least for immediate-term pain.
TSA
Research score: 4/5