NSAIDs reduce spinal pain but are not "clinically important"


Background: Although neck and low back pain are leading causes of pain and disability, there is no consensus first-line pharmacologic therapy for treatment. Recent research has pointed to acetaminophen as being ineffective, which – in combination with increased awareness of opioid dependency and adverse risks – could lead to greater use of NSAIDs.

Study design: Systematic review and meta-analysis.

Setting: Randomized controlled trials.

Synopsis: Researchers used MEDLINE, EMBASE, CINAHL, CENTRAL, and LILACS to select 35 randomized, placebo-controlled trials evaluating the impact of NSAIDs on reducing spinal pain and disability from a total of 302 full-text articles. Trial data were pooled based on follow-up time and outcomes. Pain and disability outcomes were converted to a 100-point scale with a 10-point difference between groups defined as “clinically important.” NSAIDs were found to offer greater pain reduction than placebo in the immediate (number needed to treat, 5; 95% confidence interval, 4-6) and short (NNT, 6; 95% CI, 4-10) range. However, this effect did not meet the specified 10-point difference to support “clinical importance,” despite having favorable numbers needed to treat. Limited corresponding safety analysis did not find significant adverse event rate differences other than increased reporting of gastrointestinal symptoms.

Bottom line: NSAIDs reduce spinal pain, compared with placebo, with low numbers needed to treat, but nevertheless were not determined to have a “clinically important” effect.

Citation: Machado GC et al. Nonsteroidal anti-inflammatory drugs for spinal pain: A systematic review and meta-analysis. Ann Rheum Dis. 2017 Jul;76(7):1269-78.

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