Overview of Pain Relievers for Acute Low Back Pain: What Current Evidence Says
Researchers from the University of New South Wales have explored decades of data to understand how well commonly used pain medicines work for acute low back pain. Despite nearly 60 years of study, the evidence remains unclear about the true safety and effectiveness of these drugs for short-term back pain, as reported in a study published in BMJ.
Analgesics such as paracetamol, ibuprofen, and codeine are widely used to treat acute, nonspecific low back pain that lasts less than six weeks. These medications are often chosen because they seem to offer quick relief, helping people return to daily activities, work, and exercise. Yet the new synthesis questions whether these everyday choices live up to the expectations that patients place on them and that clinicians have relied upon for years.
The analysis drew data from 98 randomized controlled trials considered high quality, with enrollment spanning from 1964 to 2021. In total, more than 15,000 adults participated, and researchers evaluated the impact of 69 distinct drugs or drug combinations. This extensive review aimed to capture a broad view of how pharmacological options perform across different populations and study designs, reflecting the real-world decisions patients and doctors face when treating acute back pain.
Among the findings, there appears to be low or very low certainty regarding the benefits of several specific medications. The muscle relaxant tolperisone demonstrated limited evidence of meaningful improvement over placebo. The combination of the anti-inflammatory aceclofenac with the muscle relaxant tizanidine similarly showed minimal advantages in reducing pain or improving function in the short term. Anticonvulsants such as pregabalin and anti-inflammatory ketoprofen also did not reveal strong evidence of superiority over placebo in this particular patient group. These results highlight that, for many patients, the expected gains from these drugs may be smaller than hoped and that some effects may be uncertain or inconsistent across studies.
Given the potential side effects and the variable quality of the available data, the review authors urge clinicians and patients to exercise caution when treating acute nonspecific low back pain with pain medications until more robust research advances. The message is not a simple call to abandon pharmacotherapy but a reminder to weigh imperfect evidence against the risks of adverse events, drug interactions, and individual patient circumstances. Clinicians are encouraged to consider non-drug strategies, such as education, physical activity, and targeted therapies, as part of a comprehensive plan. When medications are used, careful dose planning, close monitoring, and a preference for the lowest effective dose for the shortest necessary duration are prudent approaches. This synthesis underscores the need for ongoing, high-quality trials to better clarify which patients stand to benefit most from pharmacological treatment and which options may be safer or less effective in the short term.
Overall, the findings contribute to a more nuanced understanding of how analgesics perform in the initial weeks of acute low back pain. While many people seek quick relief, the evidence suggests a balanced approach that prioritizes safety and functional recovery, with medications serving as just one component of a broader treatment plan. Further well-designed research is essential to provide clearer guidance for clinicians and patients facing this common health concern.