In common low back pain, the 2019 HAS recommendations recommend non-pharmacological measures in the first line: reassuring the patient, encouraging him to practice physical activity and teaching him to self-manage the symptoms. Although they have no place in first intention, analgesics are often prescribed during painful attacks. However, in the absence of consensus, the practitioner must choose between many specialties, with very different properties in terms of efficacy and tolerance. There are few studies comparing different treatments. The authors of this meta-analysis published in the BMJ reviewed the bibliographic literature available on this subject between 1964 and 2021.
Thus, this meta-analysis included 98 randomized controlled trialswith a total of 15,134 participants and 69 different analgesic drugs or combinations. Participants were adults who reported acute nonspecific low back pain for less than six weeks (49% female; mean age 30-60 years, pain duration 24 hours to 21 days). In the various trials included, the drugs (NSAIDs, paracetamol, opioids, anticonvulsants, muscle relaxants, corticosteroids, antidepressants) were compared either with another analgesic drug, or with a placebo or with no treatment.
The main endpoints were the intensity of low back pain (scale from 0 to 100) at the end of treatment and safety (number of participants who reported an adverse event during treatment).
