EFFICACY OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS FOR LOW-BACK-PAIN - ASYSTEMATIC REVIEW OF RANDOMIZED CLINICAL-TRIALS

Purpose-To assess the efficacy of non-steroidal anti-inflammatory drug s (NSAIDs) for low back pain. Data sources-Computer aided search of pu blished randomised clinical trials and assessment of the methods of th e studies. Study selection-26 randomised clinical trials evaluating NS AIDs for low back pain were identified. Data extraction-Score for qual ity (maximum = 100 points) of the methods based on four categories: st udy population; interventions; effect measurement; data presentation a nd analysis. Determination of success rate per study group and evaluat ion of different contrasts. Statistical pooling of placebo controlled trials in similar patient groups and using similar outcome measures. R esults-The methods scores of the trials ranged from 27 to 83 points. N SAIDs were compared with placebo treatment in 10 studies. The pooled o dds ratio in four trials comparing NSAIDs with placebo after one week was 0.53 (95% confidence intervals 0.32 to 0.89) using the fixed effec t model, indicating a significant effect in favour of NSAIDs compared with placebo. In nine studies NSAIDs were compared with other (drug) t herapies. Of these, only two studies reported better results of NSAIDs compared with paracetamol with and without dextropropoxyphene. In the other trials NSAIDs were not better than the reference treatment. In 11 studies different NSAIDs were compared, of which seven studies repo rted no differences in effect. Conclusions-There are flaws in the desi gn of most studies. The pooled odds ratio must be interpreted with cau tion because the trials at issue, including the high quality trials, d id not use identical outcome measures. The results of the 26 randomise d trials that have been carried out to date, suggest that NSAIDs might be effective for short-term symptomatic relief in patients with uncom plicated low back pain, but are less effective or ineffective in patie nts with low back pain with sciatica and patients with sciatica with n erve root symptoms.