title: Systemic Pharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline.
abstract: BACKGROUND
  A 2007 American College of Physicians guideline addressed pharmacologic options for low back pain. New evidence and medications have now become available.
  
  
  OBJECTIVE
  To review the current evidence on systemic pharmacologic therapies for acute or chronic nonradicular or radicular low back pain.
  
  
  METHODS
  Ovid MEDLINE (January 2008 through November 2016), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and reference lists.
  
  
  METHODS
  Randomized trials that reported pain, function, or harms of systemic medications versus placebo or another intervention.
  
  
  METHODS
  One investigator abstracted data, and a second verified accuracy; 2 investigators independently assessed study quality.
  
  
  RESULTS
  The number of trials ranged from 9 (benzodiazepines) to 70 (nonsteroidal anti-inflammatory drugs). New evidence found that acetaminophen was ineffective for acute low back pain, nonsteroidal anti-inflammatory drugs had smaller benefits for chronic low back pain than previously observed, duloxetine was effective for chronic low back pain, and benzodiazepines were ineffective for radiculopathy. For opioids, evidence remains limited to short-term trials showing modest effects for chronic low back pain; trials were not designed to assess serious harms. Skeletal muscle relaxants are effective for short-term pain relief in acute low back pain but caused sedation. Systemic corticosteroids do not seem to be effective. For effective interventions, pain relief was small to moderate and generally short-term; improvements in function were generally smaller. Evidence is insufficient to determine the effects of antiseizure medications.
  
  
  CONCLUSIONS
  Qualitatively synthesized new trials with prior meta-analyses. Only English-language studies were included, many of which had methodological shortcomings. Medications injected for local effects were not addressed.
  
  
  CONCLUSIONS
  Several systemic medications for low back pain are associated with small to moderate, primarily short-term effects on pain. New evidence suggests that acetaminophen is ineffective for acute low back pain, and duloxetine is associated with modest effects for chronic low back pain.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality. (PROSPERO: CRD42014014735).
authors.affiliation: From Oregon Health & Science University, Portland, Oregon; University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Roger
authors.initials: R
authors.lastname: Chou
authors.affiliation: From Oregon Health & Science University, Portland, Oregon; University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Richard
authors.initials: R
authors.lastname: Deyo
authors.affiliation: From Oregon Health & Science University, Portland, Oregon; University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Janna
authors.initials: J
authors.lastname: Friedly
authors.affiliation: From Oregon Health & Science University, Portland, Oregon; University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Andrea
authors.initials: A
authors.lastname: Skelly
authors.affiliation: From Oregon Health & Science University, Portland, Oregon; University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Melissa
authors.initials: M
authors.lastname: Weimer
authors.affiliation: From Oregon Health & Science University, Portland, Oregon; University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Rochelle
authors.initials: R
authors.lastname: Fu
authors.affiliation: From Oregon Health & Science University, Portland, Oregon; University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Tracy
authors.initials: T
authors.lastname: Dana
authors.affiliation: From Oregon Health & Science University, Portland, Oregon; University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Paul
authors.initials: P
authors.lastname: Kraegel
authors.affiliation: From Oregon Health & Science University, Portland, Oregon; University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Jessica
authors.initials: J
authors.lastname: Griffin
authors.affiliation: From Oregon Health & Science University, Portland, Oregon; University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Sara
authors.initials: S
authors.lastname: Grusing
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D059787:Acute Pain / Q000188:drug therapy* / Q000209:etiology; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy* / Q000209:etiology; D009465:Neuromuscular Agents / Q000627:therapeutic use; D011843:Radiculopathy / Q000150:complications
chemical_list: D000305:Adrenal Cortex Hormones; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants; D000928:Antidepressive Agents; D009465:Neuromuscular Agents; D001569:Benzodiazepines; D000082:Acetaminophen