What is the recommended Non-Steroidal Anti-Inflammatory Drug (NSAID) for chronic lower back pain?

From the Guidelines

For chronic back pain, naproxen (250-500mg twice daily) or ibuprofen (400-800mg three times daily) are commonly recommended NSAIDs, as they have been shown to have moderate, primarily short-term benefits for patients with low back pain 1.

Key Considerations

• These medications work by reducing inflammation and pain by blocking certain enzymes in your body.
• Take them with food to minimize stomach irritation.
• For longer-term use, consider celecoxib (100-200mg daily), which may cause less stomach irritation but requires a prescription.
• Limit NSAID use to the lowest effective dose for the shortest duration possible, as prolonged use can lead to stomach ulcers, kidney problems, or increased cardiovascular risks 1.

Important Safety Information

• Combining NSAIDs with acetaminophen (up to 3000mg daily in divided doses) may provide better pain relief than either alone.
• Always consult your healthcare provider before starting any medication regimen, especially if you have heart disease, kidney problems, or take other medications.
• Non-medication approaches like physical therapy, regular exercise, and proper posture should accompany NSAID treatment for better long-term outcomes.

Benefits and Risks

• NSAIDs are more effective for pain relief than acetaminophen, but they are associated with well-known gastrointestinal and renovascular risks 1.
• There is an association between exposure to cyclooxygenase-2–selective or most nonselective NSAIDs and increased risk for myocardial infarction 1.
• Clinicians should assess cardiovascular and gastrointestinal risk factors before prescribing NSAIDs and recommend the lowest effective doses for the shortest periods necessary 1.

From the Research

Recommended NSAID for Chronic Back Pain

• The study 2 found that NSAIDs are more effective than placebo in reducing pain intensity and disability in patients with chronic low back pain, but the magnitude of the effects is small and the level of evidence is low.
• The study 3 also found that NSAIDs are effective for short-term symptomatic relief in patients with acute and chronic low back pain, but effect sizes are small and there does not seem to be a specific type of NSAID that is clearly more effective than others.
• The study 4 noted that the overall impression of the efficacy of pharmacological treatments for patients with chronic low back pain is rather sobering, with small to moderate effects on pain reduction and improvement of function, and significant side effects associated with some treatments.
• The study 5 discussed current evidence pertaining to non-prescription treatment options for chronic low back pain, including NSAIDs, acetaminophen, and other medications.

Types of NSAIDs

• The study 2 found no difference in efficacy between different NSAID types, including selective versus non-selective NSAIDs.
• The study 3 found that various types of NSAIDs, including COX-2 NSAIDs, are equally effective for acute low back pain, but COX-2 NSAIDs had statistically significantly fewer side effects than traditional NSAIDs.

Safety Considerations

• The study 6 discussed the gastrointestinal risks associated with NSAIDs and how proton-pump inhibitors (PPIs) may potentiate these effects, highlighting the need for careful consideration of the risks and benefits of coadministering PPIs with NSAIDs.
• The study 2 noted that adverse events are not statistically significant more frequent in participants using NSAIDs compared to placebo, but the relatively small sample size and short follow-up in most included trials may underestimate the proportion of patients experiencing an adverse event.