Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis.
BACKGROUND
While it is now clear that paracetamol is ineffective for spinal pain, there is not consensus on the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) for this condition. We performed a systematic review with meta-analysis to determine the efficacy and safety of NSAIDs for spinal pain.


METHODS
We searched MEDLINE, EMBASE, CINAHL, CENTRAL and LILACS for randomised controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain. Reviewers extracted data, assessed risk of bias and evaluated the quality of evidence using the Grade of Recommendations Assessment, Development and Evaluation approach. A between-group difference of 10 points (on a 0-100 scale) was used for pain and disability as the smallest worthwhile effect, as well as to calculate numbers needed to treat. Random-effects models were used to calculate mean differences or risk ratios with 95% CIs.


RESULTS
We included 35 randomised placebo-controlled trials. NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo. Six participants (95% CI 4 to 10) needed to be treated with NSAIDs, rather than placebo, for one additional participant to achieve clinically important pain reduction. When looking at different types of spinal pain, outcomes or time points, in only 3 of the 14 analyses were the pooled treatment effects marginally above our threshold for clinical importance. NSAIDs increased the risk of gastrointestinal reactions by 2.5 times (95% CI 1.2 to 5.2), although the median duration of included trials was 7 days.


CONCLUSIONS
NSAIDs are effective for spinal pain, but the magnitude of the difference in outcomes between the intervention and placebo groups is not clinically important. At present, there are no simple analgesics that provide clinically important effects for spinal pain over placebo. There is an urgent need to develop new drug therapies for this condition.
The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Gustavo C
GC
Machado
The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Chris G
CG
Maher
Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.
Paulo H
PH
Ferreira
Department of Clinical Pharmacology, St Vincent's Hospital & University of New South Wales, Sydney, New South Wales, Australia.
Richard O
RO
Day
Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.
Marina B
MB
Pinheiro
The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Manuela L
ML
Ferreira
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001416:Back Pain / Q000188:drug therapy; D006801:Humans; D017116:Low Back Pain / Q000150:complications / Q000188:drug therapy*; D019547:Neck Pain / Q000150:complications / Q000188:drug therapy*; D011843:Radiculopathy / Q000150:complications / Q000188:drug therapy
D000894:Anti-Inflammatory Agents, Non-Steroidal
Analgesics; Low Back Pain; NSAIDs