Comparative Efficacy of Pharmacological Therapies for Low Back Pain: A Bayesian Network Analysis.

Jiuzhou Jiang,Hao Pan,Shunwu Fan,Pengfei Chen,Bao Qian,Liyang Song,Xianfeng Lin,Haomai Chen,Yiyun Wang

doi:10.3389/fphar.2022.811962

Abstract

Low back pain (LBP) is a common problem, but the efficacy of pharmacological therapies remains controversial. Therefore, we aimed to comprehensively evaluate and quantitatively rank various pharmacological therapies for patients with low back pain. Two meta-analyses were performed: an initial pair-wise meta-analysis, followed by network meta-analysis using a random-effects Bayesian model. We included randomized controlled trials comparing placebos, non-steroidal anti-inflammatory drugs, opioids, skeletal muscular relaxants, pregabalin (or gabapentin), and some drug combinations. The primary and secondary outcomes were pain intensity and physical function. Eighty-eight eligible trials with 21,377 patients were included. Here, we show that only skeletal muscle relaxants significantly decreased the pain intensity of acute (including subacute) low back pain. Several kinds of drugs significantly decreased the pain of chronic low back pain, but only opioids and cyclo-oxygenase 2-selective non-steroidal anti-inflammatory drugs effectively reduced pain and improved function. Pregabalin (or gabapentin) seemed to be an effective treatment to relieve pain, but it should be used with caution for low back pain.

Highlights

Low back pain (LBP), with an estimated mean point prevalence of 18.3%, is one of the greatest challenges to worldwide health. (Hoy et al, 2012)
We assessed the effects of the following single pharmacological treatments for pain relief and functional evaluations: non-steroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, skeletal muscular relaxants, cyclo-oxygenase 2 (COX2)-selective NSAIDs, γaminobutyric acid (GABA) mimetic antiepileptics, other antiepileptics, tramadol, tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRIs), duloxetine, buprenorphine, tanezumab, acetaminophen, anticholinergics, diazepam and tapentadol
NSAIDs plus skeletal muscle relaxants had the highest ranking (SUCRA = 0.77), the pooled result of this intervention was imprecise (SMD = 0.68 [95% confidence intervals (CI), −0.01 to 1.34]), and the comparison between NSAIDs plus skeletal muscle relaxants and a single skeletal muscle relaxant did not show superior potency (SMD = 0.10 [95% CI, −0.69 to 0.68])

Summary

Introduction

Low back pain (LBP), with an estimated mean point prevalence of 18.3%, is one of the greatest challenges to worldwide health. (Hoy et al, 2012). Low back pain (LBP), with an estimated mean point prevalence of 18.3%, is one of the greatest challenges to worldwide health. Most people experience LBP, and it is the dominant cause of years lived with disability. Systematic pharmacological therapy is one of the most important and basic choices to control LBP in many major international clinical guidelines (such as the American College of Physicians (ACP), (Qaseem et al, 2017), National Institute of Health and Care Excellence (NICE), (de Campos, 2017), and Evidence-Informed Primary Care Management of Low Back Pain (Canada) Various drugs are commonly used in LBP pharmacotherapy, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), skeletal muscle relaxants, antidepressants, corticosteroids, antiepileptics (pregabalin or gabapentin), and combination medications (with more than two active ingredients). Various drugs are commonly used in LBP pharmacotherapy, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), skeletal muscle relaxants, antidepressants, corticosteroids, antiepileptics (pregabalin or gabapentin), and combination medications (with more than two active ingredients). (Maher et al, 2017).

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