Low back pain affects eight out of 10 people at some point in their lives and is one of the main causes of medical consultation in primary care and work absenteeism in Spain, according to the Spanish Society of General Medicine (Semergen). The pain disappears spontaneously in many cases, but for the treatment of low back pain, drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, paracetamol and opioids are usually prescribed, which can be combined with muscle relaxants.
Currently there are still discrepancies in the management of low back pain, and although it is recommended that patients rest when the pain is very intense, from Semergen they indicate that “absolute rest when walking is impossible should be less than two days”, since Staying in bed for more than four days aggravates lumbar problems and inadequate treatment can “worsen the natural evolution” and “provoke the medicalization of the process.”
Doubts about analgesic therapies to treat low back pain
Now, a meta-analysis reviewing the results of 98 clinical trials involving 15,134 people has cast doubt on the safety and efficacy of painkillers used to relieve low back pain. The conclusion reached by its authors is that there is “considerable uncertainty” about the efficacy of these drugs to reduce the intensity of non-specific acute low back pain, which is why they consider that doctors and patients should resort to them “with caution”. The findings have been published in The BMJ (British Journal of Sports Medicine).
There is “considerable uncertainty” about the efficacy of these drugs in reducing the intensity of non-specific acute low back pain
Lucía Hipólito, researcher and tenured professor at the Faculty of Pharmacy of the University of Valencia, has pointed out in statements to SMC Spain that the conclusion of this research “is highly important for clinical practice and comes to reaffirm studies that already showed the lack of of evidence on the ability of some analgesic medications to reduce the intensity of acute low back pain. This uncertainty of the results shown by the studies really complicates decision-making by primary care clinicians when it comes to prescribing anti-inflammatories, anticonvulsants, opioids, combinations of both, paracetamol, or corticosteroids to treat this condition. Thus, without this evidence to support their use, their prescription should be limited”.
“However –he adds-, it is important to point out some of the limitations of the study that the authors themselves cite, such as the selection of patients, or the lack or high variety of the type of data on adverse effects collected in the different studies considered for this meta-analysis. It is for this very reason that the authors reaffirm the need to continue these studies in order to improve our knowledge in the use of analgesic therapies for the treatment of pain”.
“Although of great importance, the conclusions obtained are still not going to impact the treatment schemes of the patients, but they should focus attention on the result of the use of analgesics both by the patients and their doctors. , to avoid side effects and implement the necessary measures, including the change, the interruption of the use of analgesics, or the use of other non-pharmacological measures, to improve the clinical management of the patient”, concludes the expert.
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