Acute back pain: benefits and risks of current treatments

Abstract

Objective:

To review the efficacy and safety of current treatments for acute low back pain.

Research design and methods:

PubMed was searched for clinical trials in which the words, acute, back, and pain all appeared in the study summary. The search was from the earliest references included in this database (1949) until 1 May 2009. This resulted in retrieval of 129 papers. Review of study summaries indicated that 36 provided information about either a topical treatment or oral therapy for acute low back pain. In addition, studies included as part of the evidence base for the Evidence Review of American Pain Society/American Academy of Pain Medicine Evidence Review for Evaluation and Management of Low Back Pain were reviewed.

Results:

Recommended topical and systemic pharmacologic treatments for acute low back pain include application of superficial heat, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), skeletal muscle relaxants/benzodiazepines, and opioids including tramadol. Only a small number of studies compared different approaches to treatment of acute back pain and most failed to demonstrate significant differences among treatments. Available results support the view that both NSAIDs and low-level continuous heat treatment are more effective than acetaminophen and that heat treatment is also significantly more effective than ibuprofen. A potential limitation of this study is that information from trials published in journals not included in PubMed or reported only at meetings and not yet published was not included.

Conclusions:

A wide range of treatments is currently recommended for the management of patients with acute back pain and all are supported by results from controlled clinical trials.

Key words::

• Acetaminophen
• Acute back pain
• Heat
• NSAID
• Opioid
• Tramadol

Transparency

Declaration of funding

Development of this paper was supported in part by Wyeth.

Declaration of financial/other relationships

B.H.M. has disclosed that he is on the speakers’ bureau of several pharmaceutical companies, not including Wyeth.

Some peer reviewers receive honoraria from CMRO for their review work. Peer reviewer 1 of this paper has disclosed that he/she is a consultant for, and a shareholder of, Labopharm Canada. The other peer reviewer has no relevant financial relationships.

Acknowledgment

The author has disclosed that he had no outside editorial assistance in preparing this manuscript.