Article type
Year
Abstract
Introduction/Objective: To assess the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) for low-back pain.
Methods: Computer-aided search of published randomized clinical trials and assessment of the methods of the studies. Data Extraction - Score for quality (maximum = 100 points) of the methods based on four categories: study population; interventions; effect measurement; data presentation and analysis. Determination of success rate per study group and evaluation of different contrasts. Statistical pooling of placebo controlled trials in similar patient groups and using similar outcome measures.
Results: 26 randomized clinical trials evaluating NSAIDs for low-back pain were identified. The methods scores of the trials ranged from 27 to 83 points. NSAIDs were compared with placebo treatment in 10 studies. The pooled Odds Ratio in 4 trials comparing NSAIDs with placebo after 1 week was 0.53 (95% CI 0.32 - 0.89) using the fixed effect model, indicating a significant effect in favour of NSAIDs compared to placebo. In 9 studies NSAIDs were compared with other (drug) therapies. Of these, only 2 studies reported better results of NSAIDs compared to paracetamol with and without dextropropoxyphene in the other trials NSAIDs were not better than the reference treatnent. In 11 studies different NSAIDs were compared, of which 7 studies reported no differences in effect.
Discussion: There are flaws in the design of most studies. The pooled Odds Ratio must be interpreted with caution since the trials at issue, including the high quality trials, did not use identical outcome measures. The results of the 26 randomized trials which have been carried out to date, suggest that NSAIDs might be effective for short term symptomatic relief in patients with uncomplicated low back pain, but are less effective or ineffective in patients with low back pain with sciatica and patients with sciatica with nerve root symptoms.
Methods: Computer-aided search of published randomized clinical trials and assessment of the methods of the studies. Data Extraction - Score for quality (maximum = 100 points) of the methods based on four categories: study population; interventions; effect measurement; data presentation and analysis. Determination of success rate per study group and evaluation of different contrasts. Statistical pooling of placebo controlled trials in similar patient groups and using similar outcome measures.
Results: 26 randomized clinical trials evaluating NSAIDs for low-back pain were identified. The methods scores of the trials ranged from 27 to 83 points. NSAIDs were compared with placebo treatment in 10 studies. The pooled Odds Ratio in 4 trials comparing NSAIDs with placebo after 1 week was 0.53 (95% CI 0.32 - 0.89) using the fixed effect model, indicating a significant effect in favour of NSAIDs compared to placebo. In 9 studies NSAIDs were compared with other (drug) therapies. Of these, only 2 studies reported better results of NSAIDs compared to paracetamol with and without dextropropoxyphene in the other trials NSAIDs were not better than the reference treatnent. In 11 studies different NSAIDs were compared, of which 7 studies reported no differences in effect.
Discussion: There are flaws in the design of most studies. The pooled Odds Ratio must be interpreted with caution since the trials at issue, including the high quality trials, did not use identical outcome measures. The results of the 26 randomized trials which have been carried out to date, suggest that NSAIDs might be effective for short term symptomatic relief in patients with uncomplicated low back pain, but are less effective or ineffective in patients with low back pain with sciatica and patients with sciatica with nerve root symptoms.