Acute low back pain poses a significant socioeconomic burden, as it is the condition that causes the most disability worldwide. In fact, the rate of first episodes reaches 15%, and 80% of subjects experience a recurrence that prevents them from performing any activity within a year.
Low back pain is defined as acute when symptoms last between 2 and 12 weeks, but up to 60% of patients will develop chronic low back pain. Since the first episodes are usually self-limited, most patients do not seek medical attention and lack of adequate care could be one of the causes of the high recurrence rate.
However, knowledge about the best pharmacological therapy to treat it is limited, and the indications available in the literature are contradictory. Now, an analysis published in the 'Journal of Orthopedic Research' has examined which non-opioid drugs are best for treating this condition.
The analysis, which included all the randomized controlled trials published to date (18 studies with 3,478 patients), shows that muscle relaxants and non-steroidal anti-inflammatory drugs (NSAIDs) could reduce symptoms effectively and rapidly. The combination of NSAIDs and acetaminophen was associated with greater improvement than NSAIDs alone.
"This is a first step towards optimizing the treatment of acute low back pain. However, one must always take into account the specific characteristics of the patients, such as having allergies and comorbidities," said lead author Alice Baroncini, from the Hospital RWTH University of Germany.
"Future research should focus on identifying the type of drugs that not only offer the best and fastest pain relief, but also show the lowest rate of symptom recurrence," he concluded.
As recalled throughout the study, the risk factors for the transition from acute low back pain to chronic low back pain have not yet been clearly identified. However, psychological factors have been shown to play a role in this process.
The lack of contact between patients and healthcare professionals could be one of the reasons why the literature and research on acute low back pain are scarcer than on chronic low back pain, and the conclusions are often conflicting.
According to current guidelines, non-pharmacological treatment should be the first line of treatment, and pharmacological treatment can be started if the patient wishes or if first-line treatment is insufficient.
However, the evidence regarding non-pharmacological treatment of acute low back pain is scant to moderate and includes local heat, acupuncture or massage.
In terms of drug treatment, despite the lack of evidence to support the use of opioids for acute low back pain, these drugs are prescribed to almost 14 per cent of patients complaining of acute low back pain.
However, up to 95% of patients treated with opioids experience at least one adverse reaction and, in the long term, may develop tolerance and opioid-induced hyperalgesia. Recent studies have also suggested possible long-term adverse effects in patients using opioids for acute low back pain.
