van Tulder M W, Scholten R J P M, Koes B W, Deyo R A
VU University Medical Centre, Institute for Research in Extramural Medicine, van der Boechorststraat 7, Amsterdam, Netherlands, 1081 BT.
Cochrane Database Syst Rev. 2007 Jul 18(2):CD000396. doi: 10.1002/14651858.CD000396.pub2.
Non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequently prescribed medications worldwide and are widely used for patients with low back pain.
The objective of this systematic review was to assess the effects of NSAIDs in the treatment of non-specific low back pain and to assess which type of NSAID is most effective.
We searched the Medline and Embase databases and the Cochrane Controlled Trials Register (CCTR) up to and including September 1998 if reported in English, Dutch or German. We also screened references given in relevant reviews and identified trials.
Randomised trials and double-blind controlled trials of NSAIDs in non-specific low back pain with or without radiation were included.
Two authors blinded with respect to authors, institution and journal independently extracted data and assessed methodological quality. A methodological quality score was applied, and studies meeting at least six of 11 specified criteria were considered high quality studies. If data were considered clinically homogeneous, a meta-analysis was performed using a fixed effects model for statistically homogeneous subgroups and a random effects model for statistically heterogeneous subgroups. If data were considered clinically heterogeneous, a qualitative analysis was performed using a rating system with four levels of evidence (strong, moderate, limited, no).
A total of 51 trials (total number of patients = 6057) were included in this review, of which 46 were published in English and five in German. Sixteen trials (31%) were of high quality. The pooled Relative Risk for global improvement after one week was 1.24 (95% CI 1.10 , 1.41) and for additional analgesic use 1.29 (95% CI 1.05 , 1.57), indicating a statistically significant effect in favour of NSAIDs compared to placebo. The results of the qualitative analysis showed that there is conflicting evidence (level 3) that NSAIDs are more effective than paracetamol for acute low back pain, and that there is moderate evidence (level 2) that NSAIDs are not more effective than other drugs for acute low back pain. There is strong evidence (level 1) that various types of NSAIDs are equally effective for acute low back pain.
AUTHORS' CONCLUSIONS: In conclusion, the evidence from the 51 trials included in this review suggests that NSAIDs are effective for short-term symptomatic relief in patients with acute low back pain. Furthermore, there does not seem to be a specific type of NSAID which is clearly more effective than others. Sufficient evidence on chronic low back pain is still lacking.
非甾体抗炎药（NSAIDs）是全球处方量最高的药物，广泛用于腰痛患者。
本系统评价旨在评估NSAIDs治疗非特异性腰痛的效果，并评估哪种类型的NSAIDs最为有效。
检索了Medline和Embase数据库以及Cochrane对照试验注册库（CCTR），检索截至1998年9月（包括该月）且以英文、荷兰文或德文发表的文献。我们还筛选了相关综述中给出的参考文献并确定了试验。
纳入NSAIDs治疗伴有或不伴有放射痛的非特异性腰痛的随机试验和双盲对照试验。
两位对作者、机构和期刊不知情的作者独立提取数据并评估方法学质量。应用了方法学质量评分，满足11项指定标准中至少6项的研究被视为高质量研究。如果数据在临床上被认为是同质的，则使用固定效应模型对统计学上同质的亚组进行Meta分析，对统计学上异质的亚组使用随机效应模型。如果数据在临床上被认为是异质的，则使用具有四个证据水平（强、中、有限、无）的评分系统进行定性分析。
本综述共纳入51项试验（患者总数=6057），其中46项以英文发表，5项以德文发表。16项试验（31%）为高质量试验。一周后总体改善的合并相对危险度为1.24（95%CI 1.10，1.41），额外使用镇痛药的合并相对危险度为1.29（95%CI 1.05，1.57），表明与安慰剂相比，NSAIDs有统计学显著疗效。定性分析结果显示，有相互矛盾的证据（3级）表明NSAIDs治疗急性腰痛比扑热息痛更有效，有中等证据（2级）表明NSAIDs治疗急性腰痛并不比其他药物更有效。有强有力的证据（1级）表明，各种类型的NSAIDs治疗急性腰痛同样有效。
总之，本综述纳入的51项试验证据表明，NSAIDs对急性腰痛患者的短期症状缓解有效。此外，似乎没有一种特定类型的NSAIDs明显比其他类型更有效。关于慢性腰痛仍缺乏充分证据。
