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Back Pain Center Feature Story << return to Back Pain Center

Review Finds No NSAID Advantage But experts urge tailoring back pain relief to the individual (HealthDay News) -- It was once thought that non-steroidal anti-inflammatory drugs, like ibuprofen and naproxen, had an edge over acetaminophen for treating low-back pain because so-called NSAIDs also reduce inflammation, which may be causing the discomfort. But a review of the scientific evidence has comes to a different conclusion. NSAIDs are "slightly effective" for short-term symptom relief but no more effective than acetaminophen (Tylenol) for acute, low-back pain, according to the review, published in The Cochrane Library . Back pain afflicts as many as eight in 10 people, according to the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases. People often experience their first bout of low-back pain between the ages of 30 and 40, the institute says. Most low-back pain is due to injury or trauma, but it can also be the result of a degenerative condition, such as arthritis or osteoporosis, or congenital abnormalities in the spine, according to the U.S. National Institute of Neurological Disorders and Stroke. The American Chiropractic Association estimated that Americans spend a bundle -- about $50 billion annually -- on low-back pain, and that's just for the costs of medical care, workers compensation payments, and time lost from work. The figure does not include income lost on the job or reduced worker productivity. To assess the effectiveness of NSAIDs for back-pain relief, researchers examined data from 65 trials involving more than 11,000 people. The review found that: NSAIDs provided some short-term symptom relief in people with acute and chronic low-back pain who don't have sciatica (pain and tingling that radiates down the leg). NSAIDs were no better than a placebo in people with acute sciatica. Drugs such as acetaminophen, narcotic analgesics, and muscle relaxants were just as effective as NSAIDs, and acetaminophen had fewer side effects than NSAIDs. Cox-2 inhibitors, a newer type of NSAID, were as effective as traditional NSAIDs but posed fewer problems, particularly stomach ulcers. Other studies, however, have shown that some COX-2 drugs are associated with increased cardiovascular risk. "Physicians and patients with acute low-back pain, therefore, have a choice about whether to use a NSAID or [acetaminophen], and the decision should be driven by individual clinical circumstances," the study's lead reviewer said in a prepared statement. In guidelines for the treatment of low-back pain, the American Pain Society and the American College of Physicians urge clinicians to carefully weigh the benefits and risks of any drug and use medications based on the severity of "baseline" pain and functional impairment. Opioids, for example, can treat severe pain but pose risks for sedation and dependence over time, according to Dr. Roger Chou, associate professor at the Oregon Health & Science University School of Medicine and co-author of the guidelines. "Physicians and patients should discuss proven options and select the ones that best suit their specific needs," he said in a prepared statement. On the Web To learn more about back pain, visit the U.S. National Library of Medicine. SOURCES: HealthDay News ; U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Md.; U.S. National Institute of Neurological Disorders and Stroke, Bethesda, Md.; American Chiropractic Association, Arlington, Va.; Jan. 23, 2008, The Cochrane Library ; Cochrane Collaboration, news release, Jan. 23, 2008; Oregon Health & Science University, news release, Oct. 2, 2007 Author: Karen Pallarito Publication Date: Jan. 31, 2009 Copyright © 2009 ScoutNews, LLC. All rights reserved.