The Uncertainty of Analgesics for Low Back Pain: Study Findings.
A systematic review and network meta-analysis of 98 randomized controlled trials involving 15,134 participants found that the comparative effectiveness and safety of analgesic medicines for acute non-specific low back pain are uncertain. Low or very low confidence was noted in evidence for reduced pain intensity after treatment with tolperisone, aceclofenac plus tizanidine, pregabalin, and 14 other medicines compared with placebo. Increased adverse events had moderate to very low confidence with tramadol, paracetamol plus sustained release tramadol, baclofen, and paracetamol plus tramadol compared with placebo. Until higher quality randomized controlled trials of head-to-head comparisons are published, clinicians and patients are recommended to take a cautious approach to manage acute non-specific low back pain with analgesic medicines.