NSAIDs No Better Than Placebo for Spine Pain

Effect on Pain Deemed "Clinically Unimportant"

By Dynamic Chiropractic Editorial Staff

A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."

The authors also calculated that the "number needed to treat" (NNT) for a single patient to receive a meaningful benefit of NSAIDs over placebo for pain reduction was five patients in the immediate term and six in the short term. ¹

"All NSAIDs have been associated with cardiovascular and gastrointestinal risks ," ² state the authors, who found "NSAIDs were associated with higher number of patients reporting gastrointestinal adverse effects in the short-term follow-up (i.e., <14 days)."

The authors referenced additional studies relating to other drugs commonly used for spine pain. They remarked that "recent meta-analyses have shown that paracetamol [acetaminophen/Tylenol] is ineffective, ^3-4 and opioids appear only to offer small benefits for this condition." ⁵

In the paper's final paragraph, the authors conclude, "[W]hen this result is taken together with those from recent reviews on paracetamol and opioids, it is now clear that the three most widely used, and guideline-recommended medicines for spinal pain do not provide clinically important effects over placebo."

However, they end their paper with this comment: "There is an urgent need to develop new analgesics for spinal pain." Chiropractic is not mentioned in the study.

Editor's Note : For thoughts on these study findings, read Don Petersen Jr.'s Report of My Findings .

References

1. Machado GC, et al. Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis. Ann Rheum Disease ; e-pub ahead of print, Feb. 2, 2017.
2. Trelle S, et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ, 2011;342:c7086.
3. Machado GC, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomized placebo controlled trials. BMJ, 2015;350:h1225.
4. Australian Institute of Health and Welfare 2010. Medication use for arthritis and osteoporosis. Canberra: AIHW, 2010.
5. Abdel Shaheed C, et al. Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis. JAMA Intern Med, 2016;176:958-68.