In the Journals

NSAIDs offer limited benefit for spinal pain

A systematic review published in the Annals of the Rheumatic Diseases suggested that only one in six patients treated with nonsteroidal anti-inflammatory drugs for spinal pain received any significant benefit, and that these drugs may also increase the risk for gastrointestinal infections.

“There is an urgent need to develop new drug therapies for this condition,” Gustavo C. Machado, research fellow, Musculoskeletal Division, George Institute for Global Health, New South Wales, Australia, and colleagues wrote. 

According to data cited by the American Chiropractic Association (ACA), studies suggest that more than 60 million Americans use nonsteroidal anti-inflammatory drugs (NSAIDs).

"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,” Manuela L. Ferreira, PhD, a senior research fellow also from the George Institute for Global Health, said in a press release. "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 to the many millions … who suffer from this debilitating condition every year."

Machado, Ferreira and colleagues searched MEDLINE and other databases for studies evaluating NSAIDs vs. placebo for spinal pain, which includes acute or chronic low back pain or neck pain, with or without radicular symptoms such as sciatica. They identified 35 randomized placebo-controlled trials containing 6,065 participants for their review. Risk bias and the quality of the evidence was assessed, and a between-group difference of 10 points was used for pain and disability as the smallest worthwhile effect, as well as to calculate numbers needed to treat (NNT).

The researchers stated that the pooling of all included trials revealed moderate-quality evidence that NSAIDs reduced pain in the immediate- (mean difference [MD] = –9.2; 95% CI, –11.1 to –7.3) and short-term (MD = –7.7, 95% CI, –11.4 to –4.1) compared with placebo. The number needed to treat to achieve a clinically significant effect of NSAIDs over placebo on pain reduction in the immediate-term was 5 (95% CI, 4-6) and 6 (95% CI, 4-10) in the short-term. The effects of NSAIDs on disability were slightly smaller than for pain, with effect at immediate-term follow-up being –8.1 (95% CI, –11.6 to –4.6), and at short-term –6.1 (95% CI, –9.5 to –2.8). The magnitude of the difference in outcomes between the intervention and placebo groups, however, was less than the 10-point threshold for clinical importance.

Machado and colleagues also wrote that there was high-quality evidence of clinically unimportant effects of NSAIDs compared with placebo for the physical component of the SF-12 (MD –2.9, 95% CI, –3.7 to –2.1), and no benefits over placebo were found for the mental component (MD –0.3, 95% CI, –1.2 to 0.6). They also stated that their analysis revealed a significantly higher number of participants in the NSAIDs group reporting gastrointestinal adverse events, such as gastric ulcers and bleeding, compared with placebo (RR = 2.5; 95% CI, 1.2–5.2).

“[These drugs] not only don't work very well, they're causing harm. We need treatments that will actually provide substantial relief of these people's symptoms,” Machado said in a press release. “Better still we need a stronger focus on preventing back pain in the first place. We know that education and exercise programs can substantially reduce the risk of developing low back pain.”

Previous studies have shown that as many as 80% of the U.S. population will experience a back problem at some point in their lives, according to data cited by the ACA. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.

References: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693360/ (accessed 02-03-2017)

https://www.ncbi.nlm.nih.gov/pubmed/17445733 (accessed 02-03-2017)

A systematic review published in the Annals of the Rheumatic Diseases suggested that only one in six patients treated with nonsteroidal anti-inflammatory drugs for spinal pain received any significant benefit, and that these drugs may also increase the risk for gastrointestinal infections.

“There is an urgent need to develop new drug therapies for this condition,” Gustavo C. Machado, research fellow, Musculoskeletal Division, George Institute for Global Health, New South Wales, Australia, and colleagues wrote. 

According to data cited by the American Chiropractic Association (ACA), studies suggest that more than 60 million Americans use nonsteroidal anti-inflammatory drugs (NSAIDs).

"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,” Manuela L. Ferreira, PhD, a senior research fellow also from the George Institute for Global Health, said in a press release. "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 to the many millions … who suffer from this debilitating condition every year."

Machado, Ferreira and colleagues searched MEDLINE and other databases for studies evaluating NSAIDs vs. placebo for spinal pain, which includes acute or chronic low back pain or neck pain, with or without radicular symptoms such as sciatica. They identified 35 randomized placebo-controlled trials containing 6,065 participants for their review. Risk bias and the quality of the evidence was assessed, and a between-group difference of 10 points was used for pain and disability as the smallest worthwhile effect, as well as to calculate numbers needed to treat (NNT).

The researchers stated that the pooling of all included trials revealed moderate-quality evidence that NSAIDs reduced pain in the immediate- (mean difference [MD] = –9.2; 95% CI, –11.1 to –7.3) and short-term (MD = –7.7, 95% CI, –11.4 to –4.1) compared with placebo. The number needed to treat to achieve a clinically significant effect of NSAIDs over placebo on pain reduction in the immediate-term was 5 (95% CI, 4-6) and 6 (95% CI, 4-10) in the short-term. The effects of NSAIDs on disability were slightly smaller than for pain, with effect at immediate-term follow-up being –8.1 (95% CI, –11.6 to –4.6), and at short-term –6.1 (95% CI, –9.5 to –2.8). The magnitude of the difference in outcomes between the intervention and placebo groups, however, was less than the 10-point threshold for clinical importance.

Machado and colleagues also wrote that there was high-quality evidence of clinically unimportant effects of NSAIDs compared with placebo for the physical component of the SF-12 (MD –2.9, 95% CI, –3.7 to –2.1), and no benefits over placebo were found for the mental component (MD –0.3, 95% CI, –1.2 to 0.6). They also stated that their analysis revealed a significantly higher number of participants in the NSAIDs group reporting gastrointestinal adverse events, such as gastric ulcers and bleeding, compared with placebo (RR = 2.5; 95% CI, 1.2–5.2).

“[These drugs] not only don't work very well, they're causing harm. We need treatments that will actually provide substantial relief of these people's symptoms,” Machado said in a press release. “Better still we need a stronger focus on preventing back pain in the first place. We know that education and exercise programs can substantially reduce the risk of developing low back pain.”

Previous studies have shown that as many as 80% of the U.S. population will experience a back problem at some point in their lives, according to data cited by the ACA. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.

References: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693360/ (accessed 02-03-2017)

https://www.ncbi.nlm.nih.gov/pubmed/17445733 (accessed 02-03-2017)