Faculty of Pharmacy, University of Sydney, Sydney, Australia.
George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
J Pain. 2014 Jan;15(1):2-15. doi: 10.1016/j.jpain.2013.09.016. Epub 2013 Oct 14.
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.
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.
本系统评价评估了针对急性腰痛患者可提供的非处方干预措施和建议的随机对照试验的证据。对 MEDLINE、Embase、Cochrane 系统评价数据库、AMED、CENTRAL 和 PsycINFO 进行了检索，以寻找合格的随机对照试验。主要结局指标是疼痛。合格的对照包括安慰剂、无治疗或常规护理。两位评审员提取数据并评估研究质量。使用随机效应模型汇总试验效应，使用 GRADE 标准描述总体证据强度。纳入了 13 项评估建议、卧床休息、简单镇痛药（对乙酰氨基酚、非甾体抗炎药）、热应用和局部擦剂的随机对照试验（2847 名参与者）。有低质量证据表明卧床休息无效，非常低质量证据表明短期、中期和长期建议无效。有非常低质量证据表明非甾体抗炎药（布洛芬和双氯芬酸“按需”给药）具有即刻镇痛效果（平均差异-10.9 [95%置信区间=-17.6 至-4.2] 和-11.3 [95%置信区间=-17.8 至-4.9]）。有非常低质量证据表明热包和辣椒素擦剂具有即刻镇痛效果（平均差异-13.5 [95%置信区间=-21.3 至-5.7] 和 17.5，P<.001），但没有关于长期结局的信息。
有限的证据表明，非甾体抗炎药、热包和擦剂可缓解急性腰痛的即时疼痛，而卧床休息和建议均无效。需要进一步的研究为急性腰痛患者合理使用非处方药物和建议提供证据。
