Details of trials comparing the efficacy of NSAID with other (drug) therapies for low back pain
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First author (reference) | NSAIDs dose/frequency/duration (no of patients) | Reference treatment(s) (no of patients) |
Methods score | Results4-150 |
| Hickey34 | (i) diflunisal 500 mg capsules/twice d/4 wk (16) | (ii) paracetamol 1000 mg/four times d/4 wk (13) | 61 | No of patients with none or mild low back pain after 2 and 4 weeks (i) 11, 13 (ii) 9, 7. Significantly more patient in (i) (10 out of 16) considered the therapy as good or excellent (ii) (4 out of 12). Side effects similar (i) 2 (ii) 1 |
| Sweetman42 | (i) mefenamic acid 500 mg three times d + placebo twice d (40) | (ii) Chlormezanone 100 mg and paracetamol 450 mg two capsules three times d + placebo three times d (42) (iii) Ethoheptazine 75 mg and meprobamate 150 mg and aspirin 250 mg two capsules + placebo three times d (40) | 49 | No of patients reporting no pain after 1 and 7 days (i) 7, 21 (ii) 12, 23 (iii) 10, 20. No of patients with adverse events (i) 9 (ii) 10 (iii) 16 |
| Videman45 | (i) diflunisal 250 mg capsule/4 times d/3 wk (35) | (ii) meptazinol 200 mg capsule/4 times d/3 wk (35) | 49 | Mean change in degree of pain on 100 mm VAS at three weeks (i) 45 (ii) 40. Similar improvement regarding capacity for daily tasks (data in graphs). No significant differences. (Side effects similar (i) 19 (ii) 23 patients) |
| Wiesel46 | (i) aspirin 625 mg capsules/4 times d/2 wk (−) (ii) phenylbutazone 100 mg capsules/4 times d (first 5 days). No further information given (−) | (iii) acetaminophen (dosage not given)/twice d (2 wk) (−) | 42 | Mean no of days before return to full activity (i) 5.7 (ii) 6.5 (iii) 5.7. No significant differences. No data on side effects given |
| Waterworth48 | (i) diflunisal 500 mg capsules, 1000 mg immediately, 500 mg twice d/10 d (36) | (ii) physiotherapy: local heat, ultrasound and exercises (5 × 45 min session weekly) (34) (iii) spinal manipulation and/or McKenzie therapy (5 × 45 min session weekly) (38) | 38 | Mean change in pain intensity on 4 points scale after 4 and 12 days: (i) −0.9, −1.7 (ii) −0.9, −1.6 (iii) −1.1, −1.7. No significant differences in pain and mobility |
| Brown49 | (i) diflunisal (capsules)/initial dose 1000 mg, 500 mg every 12 hours/15 d (19) | (ii) acetaminophen 300 mg with codeine 50 mg/two capsules initially one capsule every 4 h/15 d (21) | 38 | Pain assessment by patient and investigator on 3 point ordinal scale show similar improvement curves (data in graphs). No of patient rating drugs as excellent or very good (i) 9 (ii) 9. No significant differences. Side effects; more side effects in (ii) 10 than in (i) 3 |
| Evans30 | (i) aspirin 300 mg/3 capsule 4 times d/1 wk (30) (ii) indomethacin 50 mg/3 times d/1 wk (30) (iii) mefanamic acid 250 mg/2 capsules 3 times d/l wk (30) (iv) phenylbutazone 100 mg/3 times d d/1 wk (30) | (v) dextropropoxyphene 32.5 mg and paracetamol 325 mg capsules/2 capsules 4 times d/1 wk (30) (vi) paracetamol 500 mg capsules/2 capsules 4 times d/1 wk (30) | 34 | Mean daily pain index during intervention period (on point ordinal scale) (i) 1.4 (ii) 1.5 (iii) 1.4 (iv) 1.4 (v) 1.7 (vi) 1.7. (iii) significantly different from (v and vi). (i) significantly different from (v). Side effects: more side effects in (i) 20 (ii) 19 (v) 19 than in (iii) 12 (vi) 12 (iv) 4 |
| Basmajian21 | (i) diflunisal capsules 500 mg/twice d (–) (ii) diflunisal capsules 500 mg + 5 mg cyclobenzaprine/twice d (–) | (iii) cyclobenzaprine capsules 5 mg/twice d (−) | 30 | No of patients reporting marked improvement after 2, 4, and 7 days. (i) 10, 14, 24 (ii) 10,14,31 (iii) 8, 18, 30. Group (ii) significantly better after 4 days (based on total distribution). No other significant differences were found. No significant side effects were found |
| Postacchini19 | (i) diclofenac ‘full dosage’/10-14 days (acute patients), 15-20 days (chronic patients) (81) | (ii) chiropractic manipulation (87) (iii) physiotherapy (78) (iv) bed rest (29) (v) back school (50) (vi) placebo (anti-oedema gel) (73) | 27 | Mean improvement on combined pain, disability, and spinal mobiltiy score (5-32) after 3 wks, 2, and 6 mths. In subgroup with acute pain (i) 3.0, 10.7, 14.0 (ii) 7.5, 9.7, 12.3 (iii) 5.0, 8.4, 10.2 (iv) 5.4, 7.5, 7.3 (v) not included (vi) 1.8, 7.3, 11.0. Group (ii) significantly better than others after 3 wks; no other differences. In subgroup with chronic pain (i) 2.6, 2.2, 4.0 (ii) 2.2, 2.6, 4.3 (iii) 3.9, 4.2, 6.0 (iv) not included (v) 0.5, 4.6, 8.9 (vi) 0.7, 1.2, 2.0. Group (i) not significantly better. No data on side effects reported |
↵4-150 Results of the most important outcome measures according to the authors of the study. p Values < 0.05 were taken as significant.