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NSAIDs no better than placebo for spinal pain

No simple analgesics provide clinically important effects over placebo for spinal pain

Louise Prime

Tuesday, 07 February 2017

Non-steroidal anti-inflammatory drugs (NSAIDs) provide no clinically meaningful benefit over placebo for people with spinal pain, a large review has concluded. The authors of the study*, published in Annals of the Rheumatic Diseases, said this means there are no effective simple analgesics for spinal pain – so there is an urgent need to develop new drugs to treat it.

Paracetamol has already been shown to be ineffective in treating spinal pain, but there had previously been no agreement on whether or not NSAIDs would be useful for the same problem. So a team of researchers from Sydney, Australia conducted a systematic review and meta-analysis to investigate the efficacy and safety of NSAIDs compared with placebo in patients with spinal pain, with or without radicular pain.

They searched for published randomised, placebo-controlled controlled trials that had compared the efficacy and safety of NSAIDs with placebo for spinal pain, and found 35 eligible trials. From these they extracted data, assessed risk of bias and evaluated the quality of evidence. They then analysed data from these trials to assess whether or not NSAIDs produced a worthwhile effect on pain and disability, and also calculated numbers needed to treat.

The researchers reported that although NSAIDs did reduce both pain and disability to a small extent, the drugs provided clinically unimportant effects over placebo – and six patients needed to be treated with NSAIDs (compared with placebo) for one additional participant to experience clinically important pain reduction.

When they looked at the relative safety of NSAIDs and placebo, they found no overall difference in any event rate in 21 trials with a median treatment duration of 7 days. A separate analysis showed that during short-term follow-up (<14 days) patients taking NSAIDs were significantly more likely than those on placebo to report gastrointestinal adverse events (relative risk 2.5). No longer-term data were available, and they commented that their safety results should be interpreted with caution, given the short duration of exposure to NSAIDs in the included trials.

They concluded: “Compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term.

“When 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. There is an urgent need to develop new analgesics for spinal pain.”

* Machado GC, Maher CG, Ferreira PH et al. Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis. Ann Rheum Dis 2017. Published Online First: doi:10.1136/annrheumdis-2016-210597.

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