Drugs! And Low Back Pain

Trent Seth 22 July, 2020

Acute low back pain (ALBP) is still one of the most common and costly health problems affecting adults of all ages. It continues to cost companies, health systems, and individuals millions of dollars every year. One of the most common treatments doctors recommend for treatment is non-steroidal anti-inflammatory drugs (NSAIDs).

In April, this year, there was a Cochrane systematic review of all applicable studies comparing the effects of NSAIDs versus placebo, paracetamol, other drugs, and non-drug treatments. This was a follow up study to a Cochrane systematic review in 2008 and is considered one of the highest levels of scientific evidence.


In this review, ‘acute low back pain’ is in reference to pain in the back that is below the ribs and above the buttocks and has been present for less than 12 weeks. Study inclusion was strictly limited to those with no conflict of interest, for adults with the aforementioned acute low back pain, and had direct comparisons between treatments. Furthermore, the review assessed the effects of treatment on patients’ pain reduction, disability, global improvement, adverse events, and return to work. From this, 32 trials were included that gathered data on 5356 participants.


Despite slightly better improvements in pain and disability with NSAIDs, there was no clinical relevance found between the effects of NSAIDs and placebos in the first 3 weeks of treatment. Similarly, no clear difference was found between the number of participants who could return to work after seven days of treatment. Although not designed to investigate side effects, this review did note a similar number of side effects between people receiving NSAIDs and people receiving placebo.


These results should have major bearings on how NSAIDs are prescribed to patients, as the current shift is moving away from this practise. Currently, there are eight national guidelines focusing less on pharmacotherapy and placing the focus on:
- Early and gradual return to activity
- Patient education
- Minimal bed rest
- Psycho-social interventions to help prevent chronicity
- Analgesic medication for short periods in acute LBP


For workers and workplaces experiencing the negative effects of low back pain on productivity and absenteeism, there are options. Typically, the best approach is to be preventative and utilise the knowledge of movement and health professionals, such as physiotherapists, to reduce the risk associated with the work and worker. As highlighted earlier, education and an early return to activity are fundamental components to having a healthy workforce and physiotherapists are perfectly placed to deliver this.

To deliver sustainable change in a workforce and to deliver appropriate management when acute injuries occur, a Health Hub is the perfect solution. Employ Health is a leader in this industry, with experience delivering positive change to workplaces across Australia. Companies need to ensure they partner with a company they trust, who can assist them on the journey from reactive to proactive injury management, as the change may not be fast, but is well worth the investment in their workers.


Van der Gaag WH, Roelofs PDDM, Enthoven WTM, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for acute low back pain. Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No.: CD013581. DOI: 10.1002/14651858.CD013581.