NSAIDs and pharmacists vital in low back pain management

Patients with low back pain have been shown to respond well to non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, according to a literature review published in Pharmacy Practice by researchers at RMIT University

Following recently published Australian research finding strong evidence that paracetamol is not effective, or minimally effective, for relieving acute low back pain, NSAIDs have replaced paracetamol as the first-choice analgesic for non-specific low back pain in the current Australian Therapeutic Guidelines, as well as many international clinical guidelines.

Low back pain causes more disability globally than any other condition,^1,2 costing Australians approximately $9 billion annually in direct and indirect costs.^3,4 The condition is one of the most commonly presenting and costly conditions in the Australian healthcare system,⁵ with approximately 25% of Australians suffering.

Acute low back pain can develop into chronic pain in 10 to 15% of cases if not managed appropriately.⁶ Pharmacists play an essential role in providing holistic and evidence-based management of low back pain from a pharmacological and non-pharmacological perspective.

Dr Vincent Chan, Senior Lecturer in Pharmacy at RMIT’s School of Health and Biomedical Sciences, said Australian community pharmacists hold a pivotal role in the assessment and management of low back pain as one of the most frequently accessed primary healthcare services and first point of contact for primary healthcare inquiries.

“Paracetamol may reduce the severity of symptoms but does not aid the inflammation in the surrounding muscle layers that worsen low back pain,” Dr Chan said. “NSAIDs, such as ibuprofen, reduce inflammation and minimise the risk of acute cases becoming chronic, leading to physical disabilities.

“As most patients presenting with low back pain are treated with over-the-counter analgesics, Australian community pharmacists have an important role to play in influencing effective management of acute low back pain by following recommendations made in guidelines,” Dr Chan said.

Pharmacists are pivotal in improving patient knowledge of low back pain and appropriate use of analgesics. Improving the health literacy of patients will help promote the quality use of medicines and help minimise misuse and overuse of analgesic medicines in patients with conditions such as low back pain.⁷

References

1. Buchbinder R, Blyth FM, March LM, Brooks P, Woolf AD, Hoy DG. Placing the global burden of low back pain in context. Best Pract Res Clin Rheumatol. 2013;27(5):575-589. https://doi.org/10.1016/j.berh.2013.10.007
2. Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, Murray C, Burstein R, Buchbinder R. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968-974. https://doi.org/10.1136/annrheumdis-2013-204428
3. Maher CG, Williams C, Lin C, Latimer J. Managing low back pain in primary care. Austr Prescriber. 2011;34(5):128-132.
4. Gowan J, Roller L. Disease state management: Low back pain and the pharmacist's role. Austr J Pharm. 2014;95(1126):72-77.
5. Borenstein D, Calin A. Fast Facts: Low Back Pain. Oxford: Health Press; 2012.
6. Pillastrini P, Gardenghi I, Bonetti F, Capra F, Guccione A, Mugnai R, Violante FS. An updated overview of clinical guidelines for chronic low back pain management in primary care. Joint Bone Spine. 2012;79(2):176-185. https://doi.org/10.1016/j.jbspin.2011.03.019
7. Benrimoj SI, Frommer MS. Community pharmacy in Australia. Aust Health Rev. 2004;28(2):238-246. https://doi.org/10.1071/ah040238

Image credit: ©stock.adobe.com/au/andriano_cz