Sydney, Australia—Most clinical guidelines currently recommend acetaminophen as the first-line treatment for back pain, followed by nonsteroidal anti-inflammatory drugs (NSAIDs) and then, if nothing else is effective, an opioid prescription.

That’s according to a new Australian study which points out in Annals of the Rheumatic Diseases that none of the medications actually provide much benefit but all cause side effects.

In fact, according to the systematic review from The George Institute for Global Health, which is associated with the University of Sydney, only one in six patients treated with NSAIDs achieve any significant reduction in pain.

Earlier research from The George Institute demonstrated that paracetamol (acetaminophen) is ineffective and opioids provide minimal benefit over placebo.

Lead author Manuela Ferreira, PhD, emphasizes that the study highlights an urgent need to develop new therapies for back pain.

“Back pain is the leading cause of disability worldwide and is commonly managed by prescribing medicines such as anti-inflammatories,” she explains. “But our results show anti-inflammatory drugs actually only provide very limited short-term pain relief. They do reduce the level of pain, but only very slightly, and arguably not of any clinical significance.”

A study published previously in the journal notes that the number of disability-adjusted life years (DALYS) due to low back pain increased from 58.2 million (95% CI 39.9 million-78.1 million) in 1990 to 83 million (95% CI 56.6 million-111.9 million) in 2010. The global point prevalence of low back pain was 9.4% (95% CI 9.0-9.8), according to that study, also from Australia.

For the more recent analysis, the research team examined 35 trials involving more than 6,000 patients. They found that those using anti-inflammatories were 2.5 times more likely to suffer from gastrointestinal problems such as stomach ulcers and bleeding.

Research Fellow Gustavo Machado, PhD, pointed out that the “drugs that not only don’t work very well, they’re causing harm. We need treatments that will actually provide substantial relief of these people’s symptoms.”

“Better still we need a stronger focus on preventing back pain in the first place,” Machado added. “We know that education and exercise programs can substantially reduce the risk of developing low back pain.”

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