Are non-steroidal anti-inflammatory drugs effective for the management of neck pain and associated disorders, whiplash-associated disorders, or non-specific low back pain? A systematic review of systematic reviews by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration
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To evaluate the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs) for the management of neck pain and associated disorders (NAD), whiplash-associated disorders, and non-specific low back pain (LBP) with or without radiculopathy.
We systematically searched six databases from 2000 to 2014. Random pairs of independent reviewers critically appraised eligible systematic reviews using the Scottish Intercollegiate Guidelines Network criteria. We included systematic reviews with a low risk of bias in our best evidence synthesis.
We screened 706 citations and 14 systematic reviews were eligible for critical appraisal. Eight systematic reviews had a low risk of bias. For recent-onset NAD, evidence suggests that intramuscular NSAIDs lead to similar outcomes as combined manipulation and soft tissue therapy. For NAD (duration not specified), oral NSAIDs may be more effective than placebo. For recent-onset LBP, evidence suggests that: (1) oral NSAIDs lead to similar outcomes to placebo or a muscle relaxant; and (2) oral NSAIDs with bed rest lead to similar outcomes as placebo with bed rest. For persistent LBP, evidence suggests that: (1) oral NSAIDs are more effective than placebo; and (2) oral NSAIDs may be more effective than acetaminophen. For recent-onset LBP with radiculopathy, there is inconsistent evidence on the effectiveness of oral NSAIDs versus placebo. Finally, different oral NSAIDs lead to similar outcomes for neck and LBP with or without radiculopathy.
For NAD, oral NSAIDs may be more effective than placebo. Oral NSAIDs are more effective than placebo for persistent LBP, but not for recent-onset LBP. Different oral NSAIDs lead to similar outcomes for neck pain and LBP.
KeywordsWhiplash-associated disorders Neck pain and associated disorders Nonspecific low back pain Nonsteroidal anti-inflammatory drugs Systematic review Medication
The authors acknowledge the invaluable contributions to this review from: Angela Verven, J. David Cassidy, Douglas Gross, Gail Lindsay, John Stapleton, Leslie Verville, Margareta Nordin, Michel Lacerte, Mike Paulden, Murray Krahn, Patrick Loisel, and Roger Salhany. The authors also thank Trish Johns-Wilson at the University of Ontario Institute of Technology for her review of the search strategy. This study was funded by the Ontario Ministry of Finance and the Financial Services Commission of Ontario (RFP No.: OSS_00267175). The funding agency was not involved in the collection of data, data analysis, interpretation of data, or drafting of the manuscript. The research was undertaken, in part, thanks to funding from the Canada Research Chairs program to Dr. Pierre Côté, Canada Research Chair in Disability Prevention and Rehabilitation at the University of Ontario Institute of Technology.
Conflict of interest
Dr. Pierre Côté has received a grant from the Ontario Government, Ministry of Finance; a grant from Aviva Canada; and funding from the Canada Research Chairs program. Dr. Robert Brison and Dr. Silvano Mior have received an honorarium as a guideline expert panel member. For the remaining authors, no conflicts of interest were declared.
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