Relaxants for muscles and nonsteroidal anti-inflammatory medications (NSAIDs) successfully reduced the symptoms of acute lower back discomfort after one month of care, as a result of research taken from more than 3000 patients.

Acute lower back discomfort (LBP) is a frequent source of disability in the world with a heavy burden on the socioeconomic level, writes Alice Baroncini, MD, of RWTH University Hospital, Aachen, Germany, and colleagues.

In a study released in the journal of Orthopaedic Research,a team of investigators from Germany looked into the which nonopioid medications are the most effective for treating LBP.

The study was a result of 18 studies, totaling 3478 patients suffering from an acute lower back pain that was lesser than twelve weeks length. They chose studies that exclusively examined the lumbar spine and any studies that included opioids were ruled out. The average age of patients in all research studies is 42.5 years old, and 54% of them were females. The median time between symptoms and the treatment began is 15.1 days.

Overall, the use of muscle relaxants and NSAIDs proved effective in reducing disability and pain in acute LBP patients following about a week of treatment.

In addition, studies of a combination of NSAIDs and paracetamol (also known as acetaminophen) showed a greater improvement than NSAIDs alone, but paracetamol/acetaminophen alone had no significant impact on LBP.

The majority of patients suffering from acute LBP suffer a quick improvement and a reduction in symptoms, so the actual effect of the majority of medications is unclear, as the researchers note in their paper. The absence of any placebo effect in the research studies that were chosen reinforces the notion that nonopioid medicines aid in reducing LBP signs, the researchers write.

Yet, “While this work only concentrates on the pharmacological treatment of acute LBP but it is essential to stress that the use of medications is always a second-line option after other nonpharmacological, treatments that are not invasive have proven to be inadequate,” the researchers write.

The findings of the study were hampered by a variety of factors, including the inability to differentiate between various NSAID classes and the inability to conduct an analysis of a subset of the most effective treatment or medication for a particular class of drug and the short duration of follow-up for the research, as the authors note.

It is important to continue to research to determine the impact of various drugs on LBP Recurrence, they say.

The findings do, however, confirm the current view that NSAIDs can be successfully utilized to treat LBP. The evidence is further strengthened by the numerous studies and the low risk of bias research concludes.

Study supports Opioid Alternatives

The current study examines the common causes of morbidity in patients and suggests alternative options to the use of opioids in its treatment, Suman Pal, MBBS is a specialist of hospital medicine from the University of New Mexico, Albuquerque spoke about when he spoke to the media.

Pal said he wasn’t amazed by the results. “The results of this study are consistent with previous studies,” he said. “However the absence of the benefits of paracetamol on its own needs to be noted as crucial for the clinical setting.”

One of the most important messages for healthcare professionals is the significance that NSAIDs when it comes to LBP, Pal told Medscape. “NSAIDs whether as a stand-alone treatment or in conjunction with myorelaxants or paracetamol, are a viable treatment for patients suffering from chronic LBP.” The problem is that “Further studies are needed in order to identify the patients who would most benefits from this method,” he said.

The other research areas require more data to help determine the proper duration of treatment, considering the possibility of adverse reactions associated with long-term NSAID usage, Pal said.

The study did not receive any external funding. Researchers as well as Pal have not disclosed any financial arrangements.

J Orthop Res. Online publication on February 22nd 2023. Full text

Heidi Splete is a freelance medical journalist who has 20 decades of expertise.

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