Abstract
This systematic review evaluated evidence from randomized controlled trials investigating
interventions available over the counter and advice that could be provided to people
with acute low back pain. Searches were conducted on MEDLINE, Embase, Cochrane Database
of Systematic Reviews, AMED, CENTRAL, and PsycINFO for eligible randomized controlled
trials. The primary outcome measure was pain. Eligible controls included placebo,
no treatment, or usual care. Two reviewers extracted data and rated study quality.
A random effects model was used to pool trial effects with the overall strength of
evidence described using the GRADE criteria. Thirteen randomized controlled trials
(2,847 participants) evaluating advice, bed rest, simple analgesics (paracetamol,
nonsteroidal anti-inflammatory drugs), heat application, and a topical rubefacient
were included. There was low-quality evidence that bed rest is ineffective and very-low-quality
evidence that advice is ineffective in the short, intermediate, and long terms. There
was very-low-quality evidence that nonsteroidal anti-inflammatory drugs (ibuprofen
and diclofenac “when required” dosing) provide an immediate analgesic effect (mean
differences −10.9 [95% confidence interval = −17.6 to −4.2] and −11.3 [95% confidence
interval = −17.8 to −4.9], respectively). There is very-low-quality evidence that
heat wrap and a capsicum-based rubefacient provide an immediate analgesic effect (mean
differences −13.5 [95% confidence interval = −21.3 to −5.7] and 17.5, P < .001, respectively), but there was no information on longer-term outcomes.
Perspective
There is limited evidence that nonsteroidal anti-inflammatory drugs, heat wrap, and
rubefacients provide immediate pain relief for acute back pain and that bed rest and
advice are both ineffective. Future research is needed to provide evidence to support
rational use of over-the-counter remedies and advice for people with acute low back
pain.
Key words
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Article info
Footnotes
No specific funding from any government or not-for-profit organization was sought for this research.
C.G.M. and A.J.M. are investigators on the PACE trial (http://www.anzctr.org.au/ACTRN12609000966291.aspx), which is jointly funded by a project grant from the National Health and Medical Research Council and GlaxoSmithKline. C.A.S. is supported by an Australian Postgraduate Award.
Supplementary data accompanying this article are available online at www.jpain.org/ and www.sciencedirect.com/.
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© 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.
