NSAIDS provide limited benefit to those with low back pain

NSAIDS provide limited benefit to those with low back pain

Vanessa Jordan
Clinical question

How effective are NSAIDs compared with placebo and other comparison treatments for acute low back pain?

Bottom line

For people with acute LBP, NSAIDs were found to be slightly better in reducing pain and disability than placebo in the short term. However, the magnitude of the effect was small and probably not clinically relevant. There was no clear difference between selective cyclooxygenase-2 inhibitor NSAIDs and non‐selective NSAIDs, or for NSAIDs versus paracetamol, in reducing pain in the short term. In all cases, potential (gastrointestinal) adverse events should be taken into account.


Study populations were diverse and often heterogeneous, including a broad range of participants who varied in age and complaints. Both general practices and outpatient clinics were used for the source population. There were methodological shortcomings in the trials, but by restricting the analysis to low-risk trials, the result was consistent with the overall finding.


Acute LBP is a common health problem. It affects personal lives, causing activity limitations and work absence, but also brings with it an economic burden with high socio-economic costs. NSAIDs are often used in the treatment of LBP, particularly in people with acute LBP.

Cochrane Systematic Review

van der Gaag WH, Roelofs PDDM, Enthoven WTM, et al. Non‐steroidal anti‐inflammatory drugs for acute low back pain. Cochrane Database Syst Rev 2020, Issue 4. Art. No.: CD013581. DOI: 10.1002/14651858. CD013581. This review contains 32 trials with a total of 5356 participants.