What is the role of NSAIDs in the treatment of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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NSAIDs contain both analgesic and anti-inflammatory properties and therefore may affect mediators of the pathophysiological process. Clinical trials have demonstrated NSAIDs to be useful as a treatment for pain, but the long-term use of NSAIDs should be discouraged due to the frequent occurrence of adverse renal and gastrointestinal side effects. [18, 55]

A 2000 review and analysis of randomized and double-blind controlled trials of NSAIDs as LBP treatment revealed supportive evidence for short-term symptom relief in patients with acute LBP. Evidence of any benefit for chronic LBP or of any specific superiority of one NSAID is lacking. [64, 63] Therefore, the effect of these medications in the management of chronic musculoskeletal pain remains unclear, and no studies have demonstrated a clear superiority over aspirin. [55] Although the research does not support any specific NSAID over others, switching to different chemical families through sequential trials sometimes helps identify an agent that is the most beneficial for an individual patient. [18]

A 2015 randomized study found that compared to an NSAID alone, specifically naproxen, combination therapy offered no additional benefit to low-back pain sufferers. Data show adding cyclobenzaprine or oxycodone/acetaminophen to naproxen alone did not improve functional outcomes or pain at 1-week follow-up. [65]

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