Widely used anti-inflammatory drugs such as ibuprofen and aspirin have little more benefit than a placebo when it comes to treating back pain, a comprehensive review has found.
Researchers analysed 35 peer-reviewed trials on the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen for back pain, reviewing data from 6,065 patients.
They found that none of the analgesics offered anything more than a mild relief for back pain sufferers, and the effect was too small to be considered clinically important.
The comprehensive review, published in the journal Annals of the Rheumatic Diseases, found while the drugs offered little to no benefit, patients taking them were 2.5 times more likely to suffer from gastrointestinal problems such a stomach ulcers and bleeding.
Lead author of the paper, Associate Professor Manuela Ferreira from the George Institute for Global Health in Australia, said back pain was the leading cause of disability worldwide and was commonly managed by prescribing anti-inflammatories.
But guidelines should be updated to reflect the drugs had little benefit, she said.
“These drugs are effective for other conditions but for people with back pain, we believe there is a bigger role for other treatments,” she said.
“We are not arguing that no pain relief should be used, but people using these types should be aware the benefits are small and that their side effects can be harmful, and that discussing with their doctors the benefit of other treatments including exercise may be worthwhile.”
Professor Chris Del Mar, an evidence-based medicine specialist and professor of public health at Bond University in Queensland, Australia, said both doctors and patients tended to believe medicines for back pain were more effective than the evidence shows.
“It’s hard for doctors to say to people, ‘I don’t have anything that will make much of a difference to your back pain, so grit your teeth and bear it’,” he said.
“People want to hear, ‘I’ll give you some pills and we’ll make you feel better’, so it’s a cognitive bias. The traditional view has been ‘don’t just stand there, do something’,’ but what I teach medical students is that sometimes the correct response is ‘don’t just do something, stand there’.”
He said 99.9% of acute back pain resolved itself. But he sympathised that when people were in acute pain that affected their life they just wanted something to fix it.
“That’s one of the reasons we tend to use treatments, even when they’re not effective,” he said.
live
