Systemic pharmacologic therapies for low back pain: A systematic review for an American College of physicians clinical practice guideline

Roger Chou, Richard (Rick) Deyo, Janna Friedly, Andrea Skelly, Melissa Weimer, Rongwei (Rochelle) Fu, Tracy Dana, Paul Kraegel, Jessica Griffin, Sara Grusing

Research output: Contribution to journalReview article

71 Citations (Scopus)

Abstract

Background: A 2007 American College of Physicians guideline addressed pharmacologic options for low back pain. New evidence and medications have now become available. Purpose: To review the current evidence on systemic pharmacologic therapies for acute or chronic nonradicular or radicular low back pain. Data Sources: Ovid MEDLINE (January 2008 through November 2016), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and reference lists. Study Selection: Randomized trials that reported pain, function, or harms of systemic medications versus placebo or another intervention. Data Extraction: One investigator abstracted data, and a second verified accuracy; 2 investigators independently assessed study quality. Data Synthesis: The number of trials ranged from 9 (benzodiazepines) to 70 (nonsteroidal anti-inflammatory drugs). New evidence found that acetaminophen was ineffective for acute low back pain, nonsteroidal anti-inflammatory drugs had smaller benefits for chronic low back pain than previously observed, duloxetine was effective for chronic low back pain, and benzodiazepines were ineffective for radiculopathy. For opioids, evidence remains limited to short-term trials showing modest effects for chronic low back pain; trials were not designed to assess serious harms. Skeletal muscle relaxants are effective for short-term pain relief in acute low back pain but caused sedation. Systemic corticosteroids do not seem to be effective. For effective interventions, pain relief was small to moderate and generally short-term; improvements in function were generally smaller. Evidence is insufficient to determine the effects of antiseizure medications. Limitations: Qualitatively synthesized new trials with prior metaanalyses. Only English-language studies were included, many of which had methodological shortcomings. Medications injected for local effects were not addressed. Conclusion: Several systemic medications for low back pain are associated with small to moderate, primarily short-term effects on pain. New evidence suggests that acetaminophen is ineffedctive for acute low back pain, and duloxetine is associated with modest effects for chronic low back pain.

Original languageEnglish (US)
Pages (from-to)480-492
Number of pages13
JournalAnnals of Internal Medicine
Volume166
Issue number7
DOIs
StatePublished - Apr 4 2017

Fingerprint

Low Back Pain
Practice Guidelines
Physicians
Therapeutics
Pain
Acetaminophen
Benzodiazepines
Anti-Inflammatory Agents
Research Personnel
Neuromuscular Agents
Radiculopathy
Information Storage and Retrieval
MEDLINE
Pharmaceutical Preparations
Opioid Analgesics
Adrenal Cortex Hormones
Language
Placebos
Databases
Guidelines

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Systemic pharmacologic therapies for low back pain : A systematic review for an American College of physicians clinical practice guideline. / Chou, Roger; Deyo, Richard (Rick); Friedly, Janna; Skelly, Andrea; Weimer, Melissa; Fu, Rongwei (Rochelle); Dana, Tracy; Kraegel, Paul; Griffin, Jessica; Grusing, Sara.

In: Annals of Internal Medicine, Vol. 166, No. 7, 04.04.2017, p. 480-492.

Research output: Contribution to journalReview article

@article{59aa9eb9354746779bb17b98d8e9c134,
title = "Systemic pharmacologic therapies for low back pain: A systematic review for an American College of physicians clinical practice guideline",
abstract = "Background: A 2007 American College of Physicians guideline addressed pharmacologic options for low back pain. New evidence and medications have now become available. Purpose: To review the current evidence on systemic pharmacologic therapies for acute or chronic nonradicular or radicular low back pain. Data Sources: Ovid MEDLINE (January 2008 through November 2016), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and reference lists. Study Selection: Randomized trials that reported pain, function, or harms of systemic medications versus placebo or another intervention. Data Extraction: One investigator abstracted data, and a second verified accuracy; 2 investigators independently assessed study quality. Data Synthesis: The number of trials ranged from 9 (benzodiazepines) to 70 (nonsteroidal anti-inflammatory drugs). New evidence found that acetaminophen was ineffective for acute low back pain, nonsteroidal anti-inflammatory drugs had smaller benefits for chronic low back pain than previously observed, duloxetine was effective for chronic low back pain, and benzodiazepines were ineffective for radiculopathy. For opioids, evidence remains limited to short-term trials showing modest effects for chronic low back pain; trials were not designed to assess serious harms. Skeletal muscle relaxants are effective for short-term pain relief in acute low back pain but caused sedation. Systemic corticosteroids do not seem to be effective. For effective interventions, pain relief was small to moderate and generally short-term; improvements in function were generally smaller. Evidence is insufficient to determine the effects of antiseizure medications. Limitations: Qualitatively synthesized new trials with prior metaanalyses. Only English-language studies were included, many of which had methodological shortcomings. Medications injected for local effects were not addressed. Conclusion: Several systemic medications for low back pain are associated with small to moderate, primarily short-term effects on pain. New evidence suggests that acetaminophen is ineffedctive for acute low back pain, and duloxetine is associated with modest effects for chronic low back pain.",
author = "Roger Chou and Deyo, {Richard (Rick)} and Janna Friedly and Andrea Skelly and Melissa Weimer and Fu, {Rongwei (Rochelle)} and Tracy Dana and Paul Kraegel and Jessica Griffin and Sara Grusing",
year = "2017",
month = "4",
day = "4",
doi = "10.7326/M16-2458",
language = "English (US)",
volume = "166",
pages = "480--492",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "7",

}

TY - JOUR

T1 - Systemic pharmacologic therapies for low back pain

T2 - A systematic review for an American College of physicians clinical practice guideline

AU - Chou, Roger

AU - Deyo, Richard (Rick)

AU - Friedly, Janna

AU - Skelly, Andrea

AU - Weimer, Melissa

AU - Fu, Rongwei (Rochelle)

AU - Dana, Tracy

AU - Kraegel, Paul

AU - Griffin, Jessica

AU - Grusing, Sara

PY - 2017/4/4

Y1 - 2017/4/4

N2 - Background: A 2007 American College of Physicians guideline addressed pharmacologic options for low back pain. New evidence and medications have now become available. Purpose: To review the current evidence on systemic pharmacologic therapies for acute or chronic nonradicular or radicular low back pain. Data Sources: Ovid MEDLINE (January 2008 through November 2016), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and reference lists. Study Selection: Randomized trials that reported pain, function, or harms of systemic medications versus placebo or another intervention. Data Extraction: One investigator abstracted data, and a second verified accuracy; 2 investigators independently assessed study quality. Data Synthesis: The number of trials ranged from 9 (benzodiazepines) to 70 (nonsteroidal anti-inflammatory drugs). New evidence found that acetaminophen was ineffective for acute low back pain, nonsteroidal anti-inflammatory drugs had smaller benefits for chronic low back pain than previously observed, duloxetine was effective for chronic low back pain, and benzodiazepines were ineffective for radiculopathy. For opioids, evidence remains limited to short-term trials showing modest effects for chronic low back pain; trials were not designed to assess serious harms. Skeletal muscle relaxants are effective for short-term pain relief in acute low back pain but caused sedation. Systemic corticosteroids do not seem to be effective. For effective interventions, pain relief was small to moderate and generally short-term; improvements in function were generally smaller. Evidence is insufficient to determine the effects of antiseizure medications. Limitations: Qualitatively synthesized new trials with prior metaanalyses. Only English-language studies were included, many of which had methodological shortcomings. Medications injected for local effects were not addressed. Conclusion: Several systemic medications for low back pain are associated with small to moderate, primarily short-term effects on pain. New evidence suggests that acetaminophen is ineffedctive for acute low back pain, and duloxetine is associated with modest effects for chronic low back pain.

AB - Background: A 2007 American College of Physicians guideline addressed pharmacologic options for low back pain. New evidence and medications have now become available. Purpose: To review the current evidence on systemic pharmacologic therapies for acute or chronic nonradicular or radicular low back pain. Data Sources: Ovid MEDLINE (January 2008 through November 2016), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and reference lists. Study Selection: Randomized trials that reported pain, function, or harms of systemic medications versus placebo or another intervention. Data Extraction: One investigator abstracted data, and a second verified accuracy; 2 investigators independently assessed study quality. Data Synthesis: The number of trials ranged from 9 (benzodiazepines) to 70 (nonsteroidal anti-inflammatory drugs). New evidence found that acetaminophen was ineffective for acute low back pain, nonsteroidal anti-inflammatory drugs had smaller benefits for chronic low back pain than previously observed, duloxetine was effective for chronic low back pain, and benzodiazepines were ineffective for radiculopathy. For opioids, evidence remains limited to short-term trials showing modest effects for chronic low back pain; trials were not designed to assess serious harms. Skeletal muscle relaxants are effective for short-term pain relief in acute low back pain but caused sedation. Systemic corticosteroids do not seem to be effective. For effective interventions, pain relief was small to moderate and generally short-term; improvements in function were generally smaller. Evidence is insufficient to determine the effects of antiseizure medications. Limitations: Qualitatively synthesized new trials with prior metaanalyses. Only English-language studies were included, many of which had methodological shortcomings. Medications injected for local effects were not addressed. Conclusion: Several systemic medications for low back pain are associated with small to moderate, primarily short-term effects on pain. New evidence suggests that acetaminophen is ineffedctive for acute low back pain, and duloxetine is associated with modest effects for chronic low back pain.

UR - http://www.scopus.com/inward/record.url?scp=85020731360&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020731360&partnerID=8YFLogxK

U2 - 10.7326/M16-2458

DO - 10.7326/M16-2458

M3 - Review article

C2 - 28192790

AN - SCOPUS:85020731360

VL - 166

SP - 480

EP - 492

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 7

ER -