Systematic review of guideline-recommended medications prescribed for treatment of low back pain

• Published in: Chiropractic & manual therapies Vol. 30; no. 1; pp. 26 - 14
• Main Authors: Price, Morgan R, Cupler, Zachary A, Hawk, Cheryl, Bednarz, Edward M, Walters, Sheryl A, Daniels, Clinton J
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.05.2022; BioMed Central; BMC
• Subjects: Acetaminophen - therapeutic use; Adrenal Cortex Hormones - therapeutic use; Analgesics; Analgesics, Opioid - therapeutic use; Anti-Bacterial Agents; Anti-inflammatory agents; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antibiotics; Anticonvulsants - therapeutic use; Antidepressants; Antidepressive Agents - therapeutic use; Back pain; Backache; Benzodiazepines - therapeutic use; Bias; Care and treatment; Clinical medicine; Clinical practice guideline; Clinical practice guidelines; Drug dosages; Drug therapy; Humans; Jargon; Low back pain; Low Back Pain - drug therapy; Muscles; Narcotics; Nonsteroidal anti-inflammatory drugs; Opioids; Pain; Pharmaceutical Preparations; Pharmaceuticals; Prescription drugs; Primary care; Systematic Review; United Kingdom > UK; United States > US; Systematic review; Drug therapy; Clinical practice guideline; Low back pain
• ISSN: 2045-709X; 2045-709X
• DOI: 10.1186/s12998-022-00435-3

To identify and descriptively compare medication recommendations among low back pain (LBP) clinical practice guidelines (CPG). We searched PubMed, Cochrane Database of Systematic Review, Index to Chiropractic Literature, AMED, CINAHL, and PEDro to identify CPGs that described the management of mechanical LBP in the prior five years. Two investigators independently screened titles and abstracts and potentially relevant full text were considered for eligibility. Four investigators independently applied the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument for critical appraisal. Data were extracted for pharmaceutical intervention, the strength of recommendation, and appropriateness for the duration of LBP. 316 citations were identified, 50 full-text articles were assessed, and nine guidelines with global representation met the eligibility criteria. These CPGs addressed pharmacological treatments with or without non-pharmacological treatments. All CPGS focused on the management of acute, chronic, or unspecified duration of LBP. The mean overall AGREE II score was 89.3% (SD 3.5%). The lowest domain mean score was for applicability, 80.4% (SD 5.2%), and the highest was Scope and Purpose, 94.0% (SD 2.4%). There were ten classifications of medications described in the included CPGs: acetaminophen, antibiotics, anticonvulsants, antidepressants, benzodiazepines, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, oral corticosteroids, skeletal muscle relaxants (SMRs), and atypical opioids. Nine CPGs, included ten medication classes for the management of LBP. NSAIDs were the most frequently recommended medication for the treatment of both acute and chronic LBP as a first line pharmacological therapy. Acetaminophen and SMRs were inconsistently recommended for acute LBP. Meanwhile, with less consensus among CPGs, acetaminophen and antidepressants were proposed as second-choice therapies for chronic LBP. There was significant heterogeneity of recommendations within many medication classes, although oral corticosteroids, benzodiazepines, anticonvulsants, and antibiotics were not recommended by any CPGs for acute or chronic LBP.