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Spine

GUIDELINE RECOMMENDATIONS ON THE PHARMACOLOGICAL MANAGEMENT OF NON-SPECIFIC LOW BACK PAIN IN PRIMARY CARE: IS THERE A NEED TO CHANGE?

The Society for Back Pain Research (SBPR) 2018 Meeting, Groningen, The Netherlands, 15–16 November 2018.



Abstract

Introduction

Analgesic drugs are often prescribed to patients with low back pain (LBP). Recommendations for non-invasive pharmacological management of LBP from recent clinical practice guidelines were compared with each other and with the best available evidence on drug efficacy.

Methods

Guideline recommendations concerning opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, antidepressants, anticonvulsants and muscle relaxants from national primary care guidelines published within the last 3 years were included in this review. For each pharmacotherapy, the most recent systematic review was included as the best available evidence on drug efficacy and common adverse effects were summarized.

Results

Eight recent national clinical practice guidelines were included in this review (from Australia, Belgium, Canada, Denmark, The Netherlands, UK and US). Guidelines are universally moving away from pharmacotherapy due to the limited efficacy and the risk of adverse effects. NSAIDs have replaced paracetamol as the first choice analgesics for LBP in many guidelines. Opioids are considered to be a last resort in all guidelines, but prescriptions of these medications have been increasing over recent years. Only limited evidence exists for the efficacy of antidepressants and anticonvulsants in chronic LBP. Muscle relaxants are one of the analgesics of first choice in the US, but aren't widely available and thus not widely recommended in most other countries.

Conclusions

Upcoming guideline updates should shift their focus from pain to function and from pharmacotherapy to non-pharmacologic treatment options.

No conflicts of interest.

Sources of funding: This review has been supported by a program grant of the Dutch Arthritis Foundation.


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