Comparative Efficacy of Pharmacological Therapies for Low Back Pain: A Bayesian Network Analysis

Low back pain (LBP) is a common problem, but the efficacy of pharmacological therapies remains controversial. Therefore, we aimed to comprehensively evaluate and quantitatively rank various pharmacological therapies for patients with low back pain. Two meta-analyses were performed: an initial pair-wise meta-analysis, followed by network meta-analysis using a random-effects Bayesian model. We included randomized controlled trials comparing placebos, non-steroidal anti-inflammatory drugs, opioids, skeletal muscular relaxants, pregabalin (or gabapentin), and some drug combinations. The primary and secondary outcomes were pain intensity and physical function. Eighty-eight eligible trials with 21,377 patients were included. Here, we show that only skeletal muscle relaxants significantly decreased the pain intensity of acute (including subacute) low back pain. Several kinds of drugs significantly decreased the pain of chronic low back pain, but only opioids and cyclo-oxygenase 2-selective non-steroidal anti-inflammatory drugs effectively reduced pain and improved function. Pregabalin (or gabapentin) seemed to be an effective treatment to relieve pain, but it should be used with caution for low back pain.

Automated summary

This study comprehensively evaluated the efficacy of different pharmacological therapies for low back pain and found that only skeletal muscle relaxants significantly decreased pain intensity in acute back pain. Several drugs significantly reduced pain in chronic back pain, but opioids and cyclo-oxygenase 2-selective non-steroidal anti-inflammatory drugs were most effective in reducing pain and improving function. Pregabalin (or gabapentin) appeared to be an effective treatment for pain relief, but caution is advised in using it for low back pain.