There is still a lack of high-certainty evidence on the effectiveness and safety of commonly used painkillers (analgesics) for short bouts of low back pain, finds an analysis of the evidence published by The BMJ.

From an initial 124 relevant trials, the researchers included 98 randomized controlled trials published between 1964 and 2021 in their analysis. These involved 15,134 participants aged 18 and over and 69 different medicines or combinations. The researchers noted low or very low confidence in evidence for reduced pain intensity (around 25 points) after treatment with muscle relaxant Tolperisone, anti-inflammatory drug Aceclofenac plus muscle relaxant Tizanidine, and the anti-convulsant drug Pregabalin, compared with placebo.

The researchers noted moderate to very low confidence evidence for increased adverse events, such as nausea, vomiting, drowsiness, dizziness, and headache, with Tramadol, Paracetamol plus sustained release Tramadol, Baclofen, as well as Paracetamol plus Tramadol compared to placebo. Moderate to low confidence evidence also suggested that these medications could increase the risk of adverse events compared to other medications.

“Our review of analgesic medicines for acute non-specific low back pain found considerable uncertainty around effects for pain intensity and safety,” the researchers write. As such, they say clinicians and patients “are advised to take a cautious approach to the use of analgesic medicines for low back pain.”

There is no reason for concern about the safety of the hands-on approach to low back pain utilized by medically trained chiropractic physicians.

Presented as a service to the community by: Union County Chiropractic Clinic, 110 Skyline Drive, Maynardville, TN (865) 992-7000 www.unioncountychiropractic.com