Backpain relief – low evidence that drugs or NSAIDS help – Meta-analysis March 2023

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Comparative effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain: systematic review and network meta-analysis

BMJ 2023; 380 doi: https://doi.org/10.1136/bmj-2022-072962 (Published 22 March 2023)
Michael A Wewege, doctoral candidate12, Matthew K Bagg, postdoctoral fellow234, Matthew D Jones, postdoctoral fellow12, Michael C Ferraro, doctoral candidate12, Aidan G Cashin, postdoctoral fellow12, Rodrigo RN Rizzo, doctoral candidate12, Hayley B Leake, postdoctoral fellow25, Amanda D Hagstrom, senior lecturer1, Saurab Sharma, postdoctoral fellow12, Andrew J McLachlan, professor6, Christopher G Maher, professor78, Richard Day, professor910, Benedict M Wand, professor11, Neil E O’Connell, reader12, Adriani Nikolakopolou, postdoctoral fellow13, Siobhan Schabrun, professor21415, Sylvia M Gustin, professor216, James H McAuley, professor12

Objective To evaluate the comparative effectiveness and safety of analgesic medicines for acute non-specific low back pain.

Design Systematic review and network meta-analysis.

Data sources Medline, PubMed, Embase, CINAHL, CENTRAL, ClinicalTrials.gov, clinicialtrialsregister.eu, and World Health Organization’s International Clinical Trials Registry Platform from database inception to 20 February 2022.

Eligibility criteria for study selection Randomised controlled trials of analgesic medicines (eg, non-steroidal anti-inflammatory drugs, paracetamol, opioids, anti-convulsant drugs, skeletal muscle relaxants, or corticosteroids) compared with another analgesic medicine, placebo, or no treatment. Adults (=18 years) who reported acute non-specific low back pain (for less than six weeks).

Data extraction and synthesis Primary outcomes were low back pain intensity (0-100 scale) at end of treatment and safety (number of participants who reported any adverse event during treatment). Secondary outcomes were low back specific function, serious adverse events, and discontinuation from treatment. Two reviewers independently identified studies, extracted data, and assessed risk of bias. A random effects network meta-analysis was done and confidence was evaluated by the Confidence in Network Meta-Analysis method.

Results 98 randomised controlled trials (15 134 participants, 49% women) included 69 different medicines or combinations. Low or very low confidence was noted in evidence for reduced pain intensity after treatment with tolperisone (mean difference -26.1 (95% confidence intervals -34.0 to -18.2)), aceclofenac plus tizanidine (-26.1 (-38.5 to -13.6)), pregabalin (-24.7 (-34.6 to -14.7)), and 14 other medicines compared with placebo. Low or very low confidence was noted for no difference between the effects of several of these medicines. Increased adverse events had moderate to very low confidence with tramadol (risk ratio 2.6 (95% confidence interval 1.5 to 4.5)), paracetamol plus sustained release tramadol (2.4 (1.5 to 3.8)), baclofen (2.3 (1.5 to 3.4)), and paracetamol plus tramadol (2.1 (1.3 to 3.4)) compared with placebo. These medicines could increase the risk of adverse events compared with other medicines with moderate to low confidence. Moderate to low confidence was also noted for secondary outcomes and secondary analysis of medicine classes.

Conclusions The comparative effectiveness and safety of analgesic medicines for acute non-specific low back pain are uncertain. Until higher quality randomised controlled trials of head-to-head comparisons are published, clinicians and patients are recommended to take a cautious approach to manage acute non-specific low back pain with analgesic medicines.

Systematic review registration PROSPERO CRD42019145257
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Founder of VitaminDWiki uses Ibuprofin, heat, topical MgCl, MgCl bath, muscle stretches and Vitamin D

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VitaminDWiki - Back Pain category contains

• Low back pain 2X more likely if very low Vitamin D – meta-analysis Nov 2017
• Back pain was found in one study to be relieved in 95% of patients by vitamin D
• Vitamin D treats many types of Chronic Pains
• Vitamin D improves bone health, which decreases back problems
• There are 42 items in the Back Pain category in VitaminDWiki
• Magnesium also reduces back pain
  - by reducing muscle tension and improving bones
• Founder of VitaminDWiki found a combination including Vit D plus Mg to be great

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VitaminDWiki - 5 Meta-analyses of Backpain

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VitaminDWiki - 7 studies of Pain and Magnesium

This list is automatically updated