Non-steroidal anti-inflammatory drugs have a small short-term effect on low-back pain

Clinical question: 
How effective are non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of non-specific low-back pain?
Bottom line: 
Compared with placebo, NSAIDs are effective for short-term symptomatic relief in patients with acute and chronic low-back pain without sciatica. However, the effect may be of marginal clinical significance. In patients with sciatica, no difference in effect between NSAIDs and placebo was found. NSAIDs are no more effective than other drugs (paracetamol/acetaminophen, narcotic analgesics and muscle relaxants).
Caveat: 
Only 42% of the studies were considered to be of high quality, and many of them had small numbers of participants. Placebo and paracetamol/acetaminophen had fewer side effects than NSAIDs, although NSAIDS had fewer side effects than muscle relaxants and narcotic analgesics. The new COX-2 NSAIDs did not seem to be any more effective than traditional NSAIDs, but were associated with fewer side effects, particularly gastric ulcers. However, other literature has shown that some COX-2 NSAIDs are associated with increased cardiovascular risk.
Context: 
NSAIDs are the most frequently prescribed medications worldwide and are widely used for patients with low-back pain. In most international guidelines for the management of low-back pain in primary care, NSAIDs are recommended as a treatment option after paracetamol/acetaminophen has been tried.
Review CD#: 
CD000396
PEARLS No: 
63
Date: 
May, 2008
Authored by: 
Brian R McAvoy