Guideline recommendations on the pharmacological management of non-specific low back pain in primary care–is there a need to change?

Marco Schreijenberg*, Bart W. Koes, Chung Wei Christine Lin

*Corresponding author for this work

Research output: Contribution to journalReviewResearchpeer-review

Abstract

Introduction: Analgesic drugs are often prescribed to patients with non-specific low back pain (NSLBP). Recommendations for non-invasive pharmacological management of NSLBP from recent clinical practice guidelines were compared with each other and with the best available evidence on drug efficacy. Areas covered: Recommendations concerning opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, antidepressants, anticonvulsants and muscle relaxants from national primary care guidelines published within the last 3 years were included in this review. For each pharmacological treatment, the most recent systematic review was included as the best available evidence on drug efficacy and common adverse effects were summarized. Expert opinion: Although differences exist between guidelines, publications are universally moving away from pharmacotherapy due to the limited efficacy and the risk of adverse effects. NSAIDs have replaced paracetamol as the first choice analgesics for NSLBP in many guidelines. Opioids are generally considered to be a last resort, but opioid prescriptions have been increasing over recent years. Upcoming guideline updates should explicitly shift their focus from pain to function and from pharmacotherapy to non-pharmacological treatments; patient education is important to make sure NSLBP patients accept these changes. To improve the quality of NSLBP care, the evidence-practice gap should be closed through guideline implementation strategies.

Original languageEnglish
JournalExpert Review of Clinical Pharmacology
Volume12
Issue number2
Pages (from-to)145-157
ISSN1751-2433
DOIs
Publication statusPublished - Feb 2019

Fingerprint

Low Back Pain
Guidelines
Acetaminophen
Pharmaceutical Preparations
Expert Testimony
Patient Education
Practice Guidelines
Prescriptions
Publications
Primary Health Care
Muscles

Keywords

  • anticonvulsants
  • antidepressants
  • guideline recommendations
  • muscle relaxants
  • Non-specific low back pain
  • NSAIDs
  • opioids
  • paracetamol
  • pharmacotherapy

Cite this

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title = "Guideline recommendations on the pharmacological management of non-specific low back pain in primary care–is there a need to change?",
abstract = "Introduction: Analgesic drugs are often prescribed to patients with non-specific low back pain (NSLBP). Recommendations for non-invasive pharmacological management of NSLBP from recent clinical practice guidelines were compared with each other and with the best available evidence on drug efficacy. Areas covered: Recommendations concerning opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, antidepressants, anticonvulsants and muscle relaxants from national primary care guidelines published within the last 3 years were included in this review. For each pharmacological treatment, the most recent systematic review was included as the best available evidence on drug efficacy and common adverse effects were summarized. Expert opinion: Although differences exist between guidelines, publications are universally moving away from pharmacotherapy due to the limited efficacy and the risk of adverse effects. NSAIDs have replaced paracetamol as the first choice analgesics for NSLBP in many guidelines. Opioids are generally considered to be a last resort, but opioid prescriptions have been increasing over recent years. Upcoming guideline updates should explicitly shift their focus from pain to function and from pharmacotherapy to non-pharmacological treatments; patient education is important to make sure NSLBP patients accept these changes. To improve the quality of NSLBP care, the evidence-practice gap should be closed through guideline implementation strategies.",
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Guideline recommendations on the pharmacological management of non-specific low back pain in primary care–is there a need to change? / Schreijenberg, Marco; Koes, Bart W.; Lin, Chung Wei Christine.

In: Expert Review of Clinical Pharmacology, Vol. 12, No. 2, 02.2019, p. 145-157.

Research output: Contribution to journalReviewResearchpeer-review

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