Pharmacological approach for the management of chronic low back pain
Keywords:
chronic low back pain, medications, doses, effectAbstract
Chronic low back pain is a common condition affecting a high percentage of the general population. Affected people report diminished quality of life due to pain and disability. In terms of pharmacological treatment, physicians have a wide variety of options to choose from non-steroidal anti-inflammatory drugs (NSAIDS), opioids, non-opioids, muscle relaxants, antidepressants, antiepileptic drugs and biologic agents. However, there is no consensus as far as the optimal treatment is concerned.
A review of the current literature was performed to assess the efficacy and possible side effects of the different pharmacological treatments used in chronic low back pain and possibly give some guidelines about their use. The Pubmed and Cochrane databases were used to identify studies regarding the pharmacological treatment of chronic low back pain.
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References
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2. Blount BW, Hart G, Ehreth JL. Description of the content of army family practice. J Am Board Fam Pract. 1993;6:143–52.
3. Woolf C., Pain: Moving from Symptom control toward Mechanism- Specific Pharmacologic Management, American College of Physicians, Ann Intern Med 2004;140:441-51
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6. Last A. et al, Chronic Low Back Pain: Evaluation and Management, American Family Physician, 2009;79(12):1067-74
7. Haldeman S, Dagenais S. A supermarket approach to the evidence informed management of chronic low back pain. Spine J. 2008;8(1):1-7.
8. Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344(5):363–70.
9. Koes B., Schreijenberg M., Tkachev A., Paracetamol for low back pain: the state of the research field, Informa UK Limited, Taylor& Francis Expert Review of Clinical Pharmacology, 2020;13(9):1059-66
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11. Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791-803.
12. Deshpande A, Furlan A, Mailis GA, et al. Opioids for chronic low-back pain. In: The Cochrane Library, Issue 3, 2007. Chichester, UK: John Wiley & Sons, Ltd. Search date 2007.
13. Chou R., Qaseem A., Snow V., et. Al, Diagnosis and treatment of low back pain: a joint clinical practice guideline from American College of Physicians and the American Society; Annals of Internal Medicine; 2007;147(7):478-91
14. Airaksinen O, Brox J, Cedraschi C, Hildebrandt J, KlaberMoffett J, Kovacs F, et al. Chapter 4 European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006;15:s192e300.
15. Akazawa M., Mimura W., Togo K., et al. Patterns of drug treatment in patients with osteoarthritis and chronic low back pain in Japan: a retrospective database study, Journal of Pain Research,2019;12:1631-48
16. Kuritzky L. et al, Nonsteroidal anti-inflammatory drugs in the treatment of low back pain, Journal of Pain Research,2012;5:579-90
17. Sprott H., Gay e. R., et al., Influence of Ibuprofen-Arginine on serum levels of nitric oxide metabolites in patients with chronic low back pain- A single- Blind, Placebo controlled Pilot Trial, Rheumatol, 2006;33:2515-18
18. O’Donnell JB, Ekman EF, Spalding WM, et al., The effectiveness of a weak opioid medication versus a cyclo-oxygenase-2 (COX-2) selective non-steroidal anti-inflammatory drug in treating flare-up of chronic low-back pain: results from two randomized, double-blind, 6-week studies. J Int Med Res. 2009;37:1789-802.
19. Toroski M. Nikfar S, Mojahedian SS et al. Comparison of the cost-utility analysis of electroacupuncture and nonsteroidal antiinflammatory drugs in the treatment of chronic low back pain, J. Acupunct Meridian Stud, 2018;11(2):62-66
20. Enthoven WTM. et al, Non-steroidal and anti-inflammatory drugs for chronic low back pain, Cochrane Database of Systematic Reviews, 2016; Issue 2
21. Van Tudler, Scholten RJ, Koes BW, Deyo RA. Nonsteroidal antiinflammatory drugs for low back pain. Cochrane Database Syst Rev. 2006;92:CD000396
22. Vorsanger GJ, Xiang J, Gana TJ, et al. Extended-release tramadol (tramadol ER) in the treatment of chronic low back pain. J Opioid Manag 2008;4:87-97
23. Freund J. Krauss C, Hooper-Lane C. How effective are opioids for chronic low back pain, The Journal of Family Practice, 2015;64(9):584-85
24. Schnitzer TJ, Gray WL, Paster RZ, Kamin M., Efficacy of tramadol in treatment of chronic low back pain. J Rheumatol 2000;27(3):772-78
25. Deyo R., Von Kroff M, Duhkroop D. Opioids for low back pain, BMJ, 2015;350:g6380
26. Krebs E, Gravely A, Nuigent S et al. Effect of Opiod vs Nonopioid Medications on Pain- Related function in patients with chronic back pain or hip or knee osteoarthritis pain, American Medical Association, 2018;319(9):872-82
27. Chang G, Chen L, Mao J. Opioid tolerance and hyperalgesia. Med Clin North Am. 2007;91(2):199-211
28. Manchikanti L., Kaye M. A., Knezevic N. N., et al., Rensponsible, safe and effective prescription of opioids for chronic non-cancer pain; American Society of Interventional Pain Physicians (ASIPP) Guidelines; Pain Physician,2017;20: S3-S92
29. Bruehl S., Burns W. J., Gupta R., et al., Endogenous opioid inhibition of chronic low back pain influences degree of back pain relief following morphine administration, Reg Anesth Pain Med, 2014;39(2):120-25
30. Edwards R. R., Dolman J. A., Michna E., et al., Changes in pain sensitivity and pain modulation during oral opioid treatment: The impact of negative affect, Pain Medicine, 2016;17:1882-91
31. Malanga G, Wolff E. Evidence-informed management of chronic low back pain with nonsteroidal anti-inflammatory drugs, muscle relaxants, and simple analgesics. Spine J. 2008;8(1):173-84
32. Van Tulder MW, Touray T, Furlan AD, et al. Muscle relaxants for non-specific low back pain. In: The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiley & Sons, Ltd. Search date 2001
33. Morris M. McCarberget B. Antidepressants and Antiepileptic Drugs for chronic Non- Cancer Pain, American Family Physician,2005;71(3):483-90
34. Urguhart M. D., Wluka E. A., et al., Efficacy of low-dose amitriptyline for chronic low back pain, Jama Intern Med, 2018; 178(11):1474-81
35. Sindrup S. et al, Antidepressants in the Treatment of Neuropathic pain, Basic & Clinical Pharmacology & Toxicology 2005;96:399-409
36. Schliessbach j., Siegenthaler A., Bütikofer L., Effect of single-dose imipramine on chronic low-back and experimentalpain. A randomized controlled trial, Plos One, 2018; May 9
37. Salerno SM, Browning R, Jackson JL., The effect of antidepressant treatment on chronic back pain: a metanalysis. Arch Intern Med 2002;162:19-24
38. Staiger TO, Gaster B, Sullivan MD, Deyo RA, Systematic review of antidepressants in the treatment of chronic low back pain. Spine, 2003;28(22):2540-45.
39. Atkinson J. H., Slater M. A., et. Al., Effects of noradrenergic and serotoninergic antidepressants on chronic low back pain intensity; Pain,1999;83(2):137-45
40. Verdu B., Decosterd I., Buclin T., et. al., 2012, Antidepressants for the management of chronic pain, Drugs. 2008;68(18):2611-32
41. Romanό C., Romano C, Bonora C et al. Pregabalin, celecoxib and their combination for treatment of chronic low back pain, J. Orthop Traumatol, 2009;10:185-91
42. Enke Oliver, Heather A., Charles H, et. al., Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis, CMAJ 2018;190:E786-93
43. Pota V., Barbansi M., Sansone P., et al. Combination therapy with transdermal buprenorphine and pregabalin for chronic low back pain, Pain Management, 2012; 2(1):23-31
44. Meng H., Fei Q., Bingqiang W., et al. Epidural injections with or without steroids in managing chronic low back pain secondary to lumbar spinal stenosis: a meta-analysis of 13 randomized controlled trials, Drug Design, Development and Therapy 2015;9:4657-67
45. Leem G. J., Epidural Steroid Injection: A need for a new clinical practice guideline, Korean J. Pain, 2014;27(3):197-99
46. Green P.W., Burke A. J., Weiss C. A. et al. The role of epidural cortisone injection in the treatment of discogenic low back pain, Clin. Orthop. Relat. Res., Nov- Dec 1980;153:121-25
47. Blomberg S., Swärdsudd K., Tibblin G. A randomized study of manual therapy with steroid injections in low back pain. Telephone interview follow-up of pain, disability, recovery and drug consumption, Eur. Spine J. 1994;3(5):246-54
48. Chou R., Deyo R., et al., Systematic Pharmacologic Therapies for low back Pain: a systematic review for an American College of Physicians clinical practice guidelines, Annals of Internal Medicine 2017;166(7):480-92.
49. Dimitroulas T., Lambe T, Raphael JH et al, Biologic Drugs as analgesics for the management of low back pain and sciatica, American Academy of Pain Medicine, Pain Medicine, 2018;20(9):1678-86.
2. Blount BW, Hart G, Ehreth JL. Description of the content of army family practice. J Am Board Fam Pract. 1993;6:143–52.
3. Woolf C., Pain: Moving from Symptom control toward Mechanism- Specific Pharmacologic Management, American College of Physicians, Ann Intern Med 2004;140:441-51
4. Chou R. Low back pain, Clinical Evidence 2010;10:1116
5. Ibraimi et al, Prevalence and Pharmacologic treatment of patients with low back pain treated at Kosovo energetic corporation, Med Arh Dec 2013;67(6):410-13
6. Last A. et al, Chronic Low Back Pain: Evaluation and Management, American Family Physician, 2009;79(12):1067-74
7. Haldeman S, Dagenais S. A supermarket approach to the evidence informed management of chronic low back pain. Spine J. 2008;8(1):1-7.
8. Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344(5):363–70.
9. Koes B., Schreijenberg M., Tkachev A., Paracetamol for low back pain: the state of the research field, Informa UK Limited, Taylor& Francis Expert Review of Clinical Pharmacology, 2020;13(9):1059-66
10. Schreijenberg M, Koes BW, Lin CC. Guideline recommendations on the pharmacological management of non-specific low back pain in primary care - is there a need to change? Expert Rev Clin Pharmacol. 2019;12(2):145-57.
11. Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791-803.
12. Deshpande A, Furlan A, Mailis GA, et al. Opioids for chronic low-back pain. In: The Cochrane Library, Issue 3, 2007. Chichester, UK: John Wiley & Sons, Ltd. Search date 2007.
13. Chou R., Qaseem A., Snow V., et. Al, Diagnosis and treatment of low back pain: a joint clinical practice guideline from American College of Physicians and the American Society; Annals of Internal Medicine; 2007;147(7):478-91
14. Airaksinen O, Brox J, Cedraschi C, Hildebrandt J, KlaberMoffett J, Kovacs F, et al. Chapter 4 European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006;15:s192e300.
15. Akazawa M., Mimura W., Togo K., et al. Patterns of drug treatment in patients with osteoarthritis and chronic low back pain in Japan: a retrospective database study, Journal of Pain Research,2019;12:1631-48
16. Kuritzky L. et al, Nonsteroidal anti-inflammatory drugs in the treatment of low back pain, Journal of Pain Research,2012;5:579-90
17. Sprott H., Gay e. R., et al., Influence of Ibuprofen-Arginine on serum levels of nitric oxide metabolites in patients with chronic low back pain- A single- Blind, Placebo controlled Pilot Trial, Rheumatol, 2006;33:2515-18
18. O’Donnell JB, Ekman EF, Spalding WM, et al., The effectiveness of a weak opioid medication versus a cyclo-oxygenase-2 (COX-2) selective non-steroidal anti-inflammatory drug in treating flare-up of chronic low-back pain: results from two randomized, double-blind, 6-week studies. J Int Med Res. 2009;37:1789-802.
19. Toroski M. Nikfar S, Mojahedian SS et al. Comparison of the cost-utility analysis of electroacupuncture and nonsteroidal antiinflammatory drugs in the treatment of chronic low back pain, J. Acupunct Meridian Stud, 2018;11(2):62-66
20. Enthoven WTM. et al, Non-steroidal and anti-inflammatory drugs for chronic low back pain, Cochrane Database of Systematic Reviews, 2016; Issue 2
21. Van Tudler, Scholten RJ, Koes BW, Deyo RA. Nonsteroidal antiinflammatory drugs for low back pain. Cochrane Database Syst Rev. 2006;92:CD000396
22. Vorsanger GJ, Xiang J, Gana TJ, et al. Extended-release tramadol (tramadol ER) in the treatment of chronic low back pain. J Opioid Manag 2008;4:87-97
23. Freund J. Krauss C, Hooper-Lane C. How effective are opioids for chronic low back pain, The Journal of Family Practice, 2015;64(9):584-85
24. Schnitzer TJ, Gray WL, Paster RZ, Kamin M., Efficacy of tramadol in treatment of chronic low back pain. J Rheumatol 2000;27(3):772-78
25. Deyo R., Von Kroff M, Duhkroop D. Opioids for low back pain, BMJ, 2015;350:g6380
26. Krebs E, Gravely A, Nuigent S et al. Effect of Opiod vs Nonopioid Medications on Pain- Related function in patients with chronic back pain or hip or knee osteoarthritis pain, American Medical Association, 2018;319(9):872-82
27. Chang G, Chen L, Mao J. Opioid tolerance and hyperalgesia. Med Clin North Am. 2007;91(2):199-211
28. Manchikanti L., Kaye M. A., Knezevic N. N., et al., Rensponsible, safe and effective prescription of opioids for chronic non-cancer pain; American Society of Interventional Pain Physicians (ASIPP) Guidelines; Pain Physician,2017;20: S3-S92
29. Bruehl S., Burns W. J., Gupta R., et al., Endogenous opioid inhibition of chronic low back pain influences degree of back pain relief following morphine administration, Reg Anesth Pain Med, 2014;39(2):120-25
30. Edwards R. R., Dolman J. A., Michna E., et al., Changes in pain sensitivity and pain modulation during oral opioid treatment: The impact of negative affect, Pain Medicine, 2016;17:1882-91
31. Malanga G, Wolff E. Evidence-informed management of chronic low back pain with nonsteroidal anti-inflammatory drugs, muscle relaxants, and simple analgesics. Spine J. 2008;8(1):173-84
32. Van Tulder MW, Touray T, Furlan AD, et al. Muscle relaxants for non-specific low back pain. In: The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiley & Sons, Ltd. Search date 2001
33. Morris M. McCarberget B. Antidepressants and Antiepileptic Drugs for chronic Non- Cancer Pain, American Family Physician,2005;71(3):483-90
34. Urguhart M. D., Wluka E. A., et al., Efficacy of low-dose amitriptyline for chronic low back pain, Jama Intern Med, 2018; 178(11):1474-81
35. Sindrup S. et al, Antidepressants in the Treatment of Neuropathic pain, Basic & Clinical Pharmacology & Toxicology 2005;96:399-409
36. Schliessbach j., Siegenthaler A., Bütikofer L., Effect of single-dose imipramine on chronic low-back and experimentalpain. A randomized controlled trial, Plos One, 2018; May 9
37. Salerno SM, Browning R, Jackson JL., The effect of antidepressant treatment on chronic back pain: a metanalysis. Arch Intern Med 2002;162:19-24
38. Staiger TO, Gaster B, Sullivan MD, Deyo RA, Systematic review of antidepressants in the treatment of chronic low back pain. Spine, 2003;28(22):2540-45.
39. Atkinson J. H., Slater M. A., et. Al., Effects of noradrenergic and serotoninergic antidepressants on chronic low back pain intensity; Pain,1999;83(2):137-45
40. Verdu B., Decosterd I., Buclin T., et. al., 2012, Antidepressants for the management of chronic pain, Drugs. 2008;68(18):2611-32
41. Romanό C., Romano C, Bonora C et al. Pregabalin, celecoxib and their combination for treatment of chronic low back pain, J. Orthop Traumatol, 2009;10:185-91
42. Enke Oliver, Heather A., Charles H, et. al., Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis, CMAJ 2018;190:E786-93
43. Pota V., Barbansi M., Sansone P., et al. Combination therapy with transdermal buprenorphine and pregabalin for chronic low back pain, Pain Management, 2012; 2(1):23-31
44. Meng H., Fei Q., Bingqiang W., et al. Epidural injections with or without steroids in managing chronic low back pain secondary to lumbar spinal stenosis: a meta-analysis of 13 randomized controlled trials, Drug Design, Development and Therapy 2015;9:4657-67
45. Leem G. J., Epidural Steroid Injection: A need for a new clinical practice guideline, Korean J. Pain, 2014;27(3):197-99
46. Green P.W., Burke A. J., Weiss C. A. et al. The role of epidural cortisone injection in the treatment of discogenic low back pain, Clin. Orthop. Relat. Res., Nov- Dec 1980;153:121-25
47. Blomberg S., Swärdsudd K., Tibblin G. A randomized study of manual therapy with steroid injections in low back pain. Telephone interview follow-up of pain, disability, recovery and drug consumption, Eur. Spine J. 1994;3(5):246-54
48. Chou R., Deyo R., et al., Systematic Pharmacologic Therapies for low back Pain: a systematic review for an American College of Physicians clinical practice guidelines, Annals of Internal Medicine 2017;166(7):480-92.
49. Dimitroulas T., Lambe T, Raphael JH et al, Biologic Drugs as analgesics for the management of low back pain and sciatica, American Academy of Pain Medicine, Pain Medicine, 2018;20(9):1678-86.
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2021-12-02
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