For low back pain initial treatment with non pharmacological agents preferable

In a new study conducted by Silvia Gianola and team, it was shown that Non-specific low back pain (NS-LBP) should be treated using non-pharmacological interventions that appear to reduce pain and impairment in the short run. NSAIDs and muscle relaxants tend to provide the best harm–benefit balance among pharmaceutical therapies.

The findings of this study were published in the British Journal of Sports Medicine on 13th April, 2021.

NS-LBP is a common illness that imposes a significant morbidity cost on society. While most recommendations agree on the first line of care during an acute episode (reassurance, counselling, and encouragement to participate in mild exercise), the relative effectiveness of second line choices is unknown. As a result, the current study attempted to investigate the efficacy of existing therapies on pain and disability outcomes in people with NS-LBP.

In the following study 46 trials (8765 individuals) were added from 6779 recognized publications between the commencement date and October 2020. To be eligible, researchers have to investigate the effects of various pharmacological and non-pharmacological therapies on disability and pain intensity in patients with NS-LBP for less than 6 weeks (acute) or 6-12 weeks (chronic) (subacute). The GRADE (Grading of Recommendation Assessment, Development, and Evaluation) technique was used to analyze the risk of bias. The study's findings evaluated pain severity and disability, as well as the occurrence of adverse events.

At the 1-week follow-up, the results showed that manual therapy, heat wrap, and exercise were the most effective non-pharmacological therapies for pain and disability reduction. At the immediate-term follow-up, nonsteroidal anti-inflammatory (NSAID) medicines and muscle relaxants were the most effective at reducing pain and impairment. Patients receiving steroids, NSAIDs, or opioids experienced mild to severe adverse effects. This study was hampered by differences in categorization systems that have evolved through time and may have altered treatment standards.

In conclusion, following the first line of therapy, NS-LBP should be treated with nonpharmacological interventions that appear to reduce pain and impairment in the first week. Among pharmaceutical therapies, NSAIDs and muscle relaxants tend to provide the greatest net balance for pain and impairment in the short term.

Reference:

Gianola S, Bargeri S, Del Castillo G, et al Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis British Journal of Sports Medicine Published Online First: 13 April 2021. doi: 10.1136/bjsports-2020-103596