Comparative safety review of current treatment options for chronic low back pain and unmet needs: a narrative review

ABSTRACT

Introduction: The healthcare expenditures in the United States are substantial for the management of refractory, chronic low back pain (CLBP). The objective of this review is to summarize and evaluate the safety profiles of different pharmacological treatment options used in the management of CLBP.

Areas covered: The authors conducted a search of randomized controlled trials (RCTs) assessing the safety profiles of different pharmacological agents used in the management of CLBP. This narrative review covered corticosteroids, opioids, antidepressants, gabapentinoids, nonsteroidal anti-inflammatory drugs, muscle relaxants, anti-nerve growth factor antibodies and topical agents, as monotherapy or in combination.

Expert opinion: The risk-benefit ratio of a particular treatment is a subject driving the ongoing development of pharmaceuticals. The most commonly reported AEs across all drug classes are of gastrointestinal nature, followed by neurological and skin-related. These AEs include nausea, dizziness, constipation, arthralgia, headache, dry mouth, pruritus, etc. The majority of the AEs reported are not life-threatening, although they may lower patients’ quality of life, thus, affecting their compliance. One of the biggest limitations of our review stems from the paucity of safety assessments in published RCTs. Advances in our understanding of the neurobiology of pain will promote development of new therapeutic strategies.

KEYWORDS:

• Chronic low back pain
• safety
• adverse events
• corticosteroids
• antidepressants
• gabapentinoids
• nsaids
• muscle relaxants
• nerve growth factors
• topical agents

Article highlights

• Randomized controlled trials (RCTs) were reviewed to summarize and evaluate the safety profiles of different pharmacological treatment options in the management of chronic low back pain.

• Treatment options covered are corticosteroids, opioids, antidepressants, gabapentinoids, nonsteroidal anti-inflammatory drugs, muscle relaxants, anti-nerve growth factor antibodies and topical agents, as monotherapy or in combination.

• The most commonly reported AEs across all drug classes are of gastrointestinal nature, followed closely by neurological and skin-related.

• There is a paucity of safety assessments in published RCTs and we encourage more researchers to consider safety at least as one of the secondary outcomes in their clinical trials.

• Active-controlled study designs and research into combination therapies may help optimize efficiency in contrast with safety.

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Declaration of interest

The author(s) have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.