Are non-steroidal anti-inflammatory drugs effective for the management of neck pain and associated disorders, whiplash-associated disorders, or non-specific low back pain? A systematic review of systematic reviews by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

@article{Wong2015AreNA,
  title={Are non-steroidal anti-inflammatory drugs effective for the management of neck pain and associated disorders, whiplash-associated disorders, or non-specific low back pain? A systematic review of systematic reviews by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration},
  author={Jessica J. Wong and Pierre C{\^o}t{\'e} and Arthur Ameis and Sharanya Varatharajan and Thepikaa Varatharajan and Heather M Shearer and Robert J. Brison and Deborah Sutton and Kristi Randhawa and Hainan Yu and Danielle Southerst and Rachel Goldgrub and Silvano Mior and Maja Stupar and Linda Carroll and Anne L Taylor-Vaisey},
  journal={European Spine Journal},
  year={2015},
  volume={25},
  pages={34-61}
}
AbstractPurposeTo evaluate the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs) for the management of neck pain and associated disorders (NAD), whiplash-associated disorders, and non-specific low back pain (LBP) with or without radiculopathy.MethodsWe systematically searched six databases from 2000 to 2014. Random pairs of independent reviewers critically appraised eligible systematic reviews using the Scottish Intercollegiate Guidelines Network criteria. We included systematic… 
Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis
TLDR
NSAIDs are effective for spinal pain, but the magnitude of the difference in outcomes between the intervention and placebo groups is not clinically important.
Review article: Best practice management of neck pain in the emergency department (part 6 of the musculoskeletal injuries rapid review series)
TLDR
Consistent evidence was found to support the use of ‘red flags’ to screen for serious pathologies, judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance in neck pain patients.
Review article: Best practice management of low back pain in the emergency department (part 1 of the musculoskeletal injuries rapid review series)
TLDR
Consistent evidence was found to support the use of ‘red flags’ to screen for serious pathologies, diagnostic tests being reserved for use only in the presence of red flags, the judicious prescribing of opioids, and identification of psychosocial risk factors as predictors of poorer outcome and promotion of early return to work and function.
Pharmacological and Interventional Management of Pain After Whiplash Injury.
  • M. Curatolo
  • Medicine
    The Journal of orthopaedic and sports physical therapy
  • 2016
Synopsis Whiplash-associated disorder (WAD) is a group of symptoms and clinical manifestations resulting from rear-end or side impact. Despite the wide use of medications in WAD, the published
Nonsteroidal Anti-inflammatory Drugs for Sciatica: An Updated Cochrane Review.
TLDR
Very low-quality evidence that the efficacy of NSAIDs for pain reduction is comparable with that of placebo, low- Quality evidence that NSAIDs is better than placebo for global improvement and low- quality evidence for higher risk of adverse effects using NSAIDs compared with placebo are shown.
Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration
TLDR
This guideline is based on recent systematic reviews of high-quality studies and considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations.
Evidence-Based Recommendations on the Pharmacological Management of Osteoarthritis and Chronic Low Back Pain: An Asian Consensus
TLDR
Topical non-steroidal anti-infl ammatory drugs (NSAIDs) are recommended as a first-line treatment for OA pain and oral NSAIDs should be considered as a second-line pharmacological treatment of cLBP.
The Chinese Association for the Study of Pain (CASP): Consensus on the Assessment and Management of Chronic Nonspecific Low Back Pain
TLDR
The principle of the management is to relieve pain, restore function, and avoid recurrence, and the emphasis should be put on the prevention of NLBP and reducing relevant risk factors.
Effectiveness of Paravertebral Ozone Therapy in Individuals with Low Back Pain with or without Radicular Pain: A Systematic Review
TLDR
The results of this review indicate that paravertebral ozone therapy could be a tool to control low back pain with or without associated radicular pain in people who have undergone other conventional therapies without success.
Medication Overuse in Chronic Pain
  • E. Hsu
  • Medicine, Biology
    Current Pain and Headache Reports
  • 2017
TLDR
This review article presents the current state of medication over use in chronic pain and proposes precaution to balance the risk and benefit ratio and may serve as a premier for future study on clinical pathway for comprehensive chronic pain management and reduce medication overuse.
...
...

References

SHOWING 1-10 OF 107 REFERENCES
Nonsteroidal Anti-Inflammatory Drugs for Low Back Pain: A Systematic Review Within the Framework of the Cochrane Collaboration Back Review Group
TLDR
The evidence from the 51 trials included in this review suggests that nonsteroidal anti-inflammatory drugs are effective for short-term symptomatic relief in patients with acute low back pain and there does not seem to be a specific type of nonsteroid anti- inflammatory drug that is clearly more effective than others.
A systematic review on the effectiveness of pharmacological interventions for chronic non-specific low-back pain
TLDR
NSAIDs and opioids seem to lead to a somewhat higher relief in pain on the short term, as compared to placebo, in patients with non-specific chronic low back pain; opioids seems to have a small effect in improving function for a selection of patients who responded with an exacerbation of their symptoms after stopping their medication.
Nonsteroidal Anti-Inflammatory Drugs for Low Back Pain: An Updated Cochrane Review
TLDR
The evidence from the 65 trials included in this review suggests that NSAIDs are effective for short-term symptomatic relief in patients with acute and chronic low back pain without sciatica, however, effect sizes are small.
Interventions available over the counter and advice for acute low back pain: systematic review and meta-analysis.
Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis
TLDR
The efficacy and tolerability of drugs commonly prescribed for the management of sciatica in primary care is unclear and the evidence to judge the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antidepressants, anticonvulsants, muscle relaxants, and opioid analgesics ranged from moderate to low quality.
Medicinal and injection therapies for mechanical neck disorders.
TLDR
In participants with chronic MND with or without radicular findings, epidural methylprednisolone and lidocaine reduced neck pain and improved function at one-year follow-up compared to the intramuscular route, and other treatments including NSAIDS and nerve blocks had unclear or limited evidence of benefit.
Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.
Drug therapy for the treatment of chronic nonspecific low back pain: systematic review and meta-analysis.
TLDR
A systematic review and meta-analysis of randomized controlled trials of drug therapy for the treatment of chronic nonspecific low back pain endorses the use of COX-2 NSAIDs as the first-line drugs for CNLBP.
Effect sizes of non-surgical treatments of non-specific low-back pain
TLDR
The effect of treatments for non-specific low-back pain is only small to moderate and there is a dire need for developing more effective interventions.
Treatment of Acute Low Back Pain With the COX-2–Selective Anti-Inflammatory Drug Nimesulide: Results of a Randomized, Double-Blind Comparative Trial Versus Ibuprofen
TLDR
The results confirmed that the COX-2–selective inhibitor nimesulide is an effective and well-tolerated agent for use in general practices to treat acutelow back pain.
...
...