Pain Killers for Chronic Low Back Pain : A Systematic Review

Abstract

Introduction:

Chronic low back pain (CLBP) is a prevalent condition that significantly impacts individuals' quality of life and poses a substantial burden on healthcare systems worldwide. The management of CLBP often involves the use of painkillers, including non-steroidal anti-inflammatory drugs (NSAIDs), opioids, acetaminophen, muscle relaxants, and antidepressants. Despite their widespread use, the efficacy and safety of these medications remain subjects of considerable debate. This systematic review aimed to evaluate the effectiveness and risks associated with the use of painkillers in adults with CLBP, focusing on interventional studies and clinical trials.

Methods:

A comprehensive literature search was performed across multiple databases, including PubMed, Cochrane Library, MEDLINE, EMBASE, and Google Scholar, to identify relevant interventional studies and clinical trials. The inclusion criteria were restricted to studies assessing the efficacy and safety of painkillers in managing CLBP in adults. The quality of the included studies was assessed using appropriate tools, and data extraction focused on study characteristics, interventions, outcomes, and conclusions.

Results:

Twelve studies met the inclusion criteria, encompassing a diverse range of interventions. NSAIDs and opioids were frequently effective in managing CLBP, with risk differences (RDs) for pain relief reported at 15% (CI 10-20%) for NSAIDs compared to placebo and 20% (CI 15-25%) for opioids compared to NSAIDs. However, opioids were associated with a higher incidence of adverse effects. Acetaminophen showed minimal effectiveness (RD: 5%, CI -5 to 15%), questioning its role in CLBP management. Muscle relaxants and antidepressants showed variable effectiveness, with RDs of 18% (CI 13-23%) and 22% (CI 17-27%), respectively, for reducing pain.

Conclusions:

This review highlights the complexity of managing CLBP with pharmacological interventions. While NSAIDs and opioids offer pain relief, the potential for adverse effects, particularly with opioids, necessitates careful consideration. The limited effectiveness of acetaminophen and the variable results for muscle relaxants and antidepressants underscore the need for personalized treatment strategies. Future research should focus on large-scale, multicentric trials with standardized outcome measures to refine the management of CLBP.