Australasian Science: Australia's authority on science since 1938

Back Pain: The Drugs Don’t Work

Non-steroidal anti-inflammatory drugs (NSAIDs) used to treat back pain provide little benefit but cause side-effects, according to a systematic review by The George Institute for Global Health. The research, published in the Annals of the Rheumatic Diseases, found that only one in six patients treated with NSAIDs achieve any significant reduction in pain.

Previous work by The George Institute has questioned the effectiveness of other medicines used to treat back pain, finding that paracetamol is ineffective and opioids provide minimal benefit over placebo. Most clinical guidelines currently recommend NSAIDs as second-line analgesics after paracetamol, with opioids coming at third choice.

Lead author A/Prof Manuela Ferreira says the study highlights an urgent need to develop new therapies to treat back pain, which affects 80% of Australians during their lifetime. “Our results show anti-inflammatory drugs actually only provide very limited short-term pain relief,” he says. “They do reduce the level of pain, but only very slightly, and arguably not of any clinical significance. When you factor in the side-effects, which are very common, it becomes clear that these drugs are not the answer to providing pain relief to the many millions of Australians who suffer from this debilitating condition every year.”

The team at The George Institute examined 35 trials involving more than 6000 people, and found that patients taking anti-inflammatories were 2.5 times more likely to suffer from gastro­intestinal problems such as stomach ulcers and bleeding.

“Millions of Australians are taking drugs that not only don’t work very well, they’re causing harm,” said Dr Gustavo Machado of The George Institute and The University of Sydney. “We need treatments that will actually provide substantial relief of these people’s symptoms. Better still, we need a stronger focus on preventing back pain in the first place. We know that education and exercise programs can substantially reduce the risk of developing low back pain.”