Pharmacotherapy for chronic non-specific low back pain: current and future options

ABSTRACT

Introduction: Low back pain is associated with a large burden-of-illness. It is responsible for the most years lived with disability as compared with any other medical condition. A comprehensive overview of the evidence on pharmacological treatment options for chronic low back pain is lacking. This review evaluates the evidence for the benefits and risks of currently available pharmacological treatments for chronic low back pain.

Areas covered: The authors focus on the recent (Cochrane) systematic reviews and meta-analyses of randomized clinical trials covering paracetamol (acetaminophen), NSAIDs, muscle relaxants, antidepressants, anticonvulsants, opioids, and other (new) drugs.

Expert opinion: The overall impression of the efficacy of pharmacological treatments for patients with chronic low back pain is rather sobering. The effects on pain reduction and improvement of function are commonly small to moderate and short lasting when compared to placebo. At the same time, the various types of drugs are not without side-effects. This holds especially true for serious side-effects associated with (prolonged) use of strong opioids. Future studies on patients with chronic back pain should aim to identify subgroups of patients with good response to specific pharmacological treatment to facilitate personalized care.

KEYWORDS:

• Anticonvulsants
• antidepressants
• chronic low back pain
• melatonin
• muscle relaxants
• NSAIDs
• opioids
• paracetamol
• acetaminophen
• pharmacotherapy
• review

Article highlights

• Pharmacological treatments are frequently prescribed for symptomatic pain relief and disability improvement in patients with chronic low back pain.

• The effects of pharmacological treatment for chronic low back pain on pain relief and function is small to moderate and short lasting compared with placebo.

• The various types of drugs are not without side-effects. This holds especially true for serious side-effects associated with (prolonged) use of strong opioids.

• Recent clinical guidelines stress the importance of firstly providing non-pharmacological care for patients with back pain.

• Future studies on patients with chronic back pain should aim to identify subgroups of patients with good response to specific pharmacological treatment to facilitate personalized care.

This box summarizes key points contained in the article.

Declaration of interest

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

Additional information

Funding

The manuscript is funded in part by a program grant from the Dutch Arthritis Foundation.