Doctors and patients are advised to take a cautious approach to the use of analgesics. Despite nearly 60 years of research, there is still a lack of high certainty evidence on the effectiveness and safety of commonly used painkillers (analgesics) for short bouts of low back pain, finds an analysis
A BMJ analysis reveals a lack of high certainty evidence for the effectiveness and safety of common painkillers in treating short-term low back pain. Researchers advise caution in using analgesic medicines until higher quality trials are available. The comprehensive review included 98 randomized controlled trials with low or very low confidence evidence for reduced pain intensity and increased adverse events.
From an initial 124 relevant trials, they included 98 randomized controlled trials published between 1964 and 2021 in their analysis. These involved 15,134 participants aged 18 and over and 69 different medicines or combinations. The researchers noted low or very low confidence in evidence for reduced pain intensity after treatment with muscle relaxant tolperisone, anti-inflammatory drug aceclofenac plus muscle relaxant tizanidine, and the anti-convulsant drug pregabalin, compared with placebo.
The researchers noted moderate to very low confidence evidence for increased adverse events, such as nausea, vomiting, drowsiness, dizziness, and headache, with tramadol, paracetamol plus sustained-release tramadol, baclofen, as well as paracetamol plus tramadol compared to placebo. Moderate to low confidence evidence also suggested that these medications could increase the risk of adverse events compared to other medications.
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