Department of Orthopaedics and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic , Aachen, Germany.
Department of Medicine, Surgery and Dentistry, University of Salerno , Allende, Baronissi (SA), Italy.
Expert Opin Pharmacother. 2021 Jan;22(1):109-119. doi: 10.1080/14656566.2020.1817384. Epub 2020 Sep 4.
Treating chronic low back pain (LBP) can be challenging, and the most effective pharmacological therapy is controversial. The present systematic review investigated the efficacy of various pharmacological compounds to achieve pain relief and improve disability in chronic LBP patients. The present study focused on acetaminophen, amoxicillin, flupirtine, baclofen, tryciclic antidepressants (TCAs), duloxetine, topiramate, gabapentinoids, non-steroid anti-inflammatory drugs (NSAIDs) and opioids.
All randomized clinical trials comparing two or more drug treatments for chronic low back pain were accessed. Studies reporting outcomes concerning patients with neurologic or mechanic, specific or aspecific low back pain with or without radiculopathy were included. LBP was considered chronic if pain had lasted more than 6 weeks. Data from 47 articles (9007 patients: mean age: 52.62 ± 7.0 years; mean BMI: 28.26 ± 2.8; mean follow-up: 3.23 ± 3.2 months) were obtained.
According to published level I evidence, only baclofen, duloxetine, NSAIDs, and opiates showed to improve pain and disability levels in patients with LBP. However, the patients' demographics are heterogeneous, and the results must be interpreted with caution and in the light of possible adverse events connected to the use of these drugs.
治疗慢性下背痛（LBP）可能具有挑战性，最有效的药物治疗存在争议。本系统评价研究了各种药物化合物在缓解慢性 LBP 患者疼痛和改善残疾方面的疗效。本研究集中于对乙酰氨基酚、阿莫西林、氟吡汀、巴氯芬、三环类抗抑郁药（TCAs）、度洛西汀、托吡酯、加巴喷丁类药物、非甾体抗炎药（NSAIDs）和阿片类药物。
所有比较两种或多种药物治疗慢性下背痛的随机临床试验均被纳入。报告有关患有神经病或机械性、特异性或非特异性下背痛伴或不伴放射痛的患者结局的研究被纳入。如果疼痛持续超过 6 周，则认为 LBP 为慢性。从 47 篇文章（9007 名患者：平均年龄：52.62 ± 7.0 岁；平均 BMI：28.26 ± 2.8；平均随访：3.23 ± 3.2 个月）中获得数据。
根据已发表的一级证据，只有巴氯芬、度洛西汀、NSAIDs 和阿片类药物显示可改善 LBP 患者的疼痛和残疾水平。然而，患者的人口统计学特征存在异质性，并且必须谨慎解释结果，并考虑到使用这些药物可能产生的不良反应。
