Non-steroidal anti-inflammatory drugs for acute low back pain - PubMed (original) (raw)

Meta-Analysis

Non-steroidal anti-inflammatory drugs for acute low back pain

Wendelien H van der Gaag et al. Cochrane Database Syst Rev. 2020.

Abstract

Background: Acute low back pain (LBP) is a common health problem. Non-steroidal anti-inflammatory drugs (NSAIDs) are often used in the treatment of LBP, particularly in people with acute LBP. In 2008, a Cochrane Review was published about the efficacy of NSAIDs for LBP (acute, chronic, and sciatica), identifying a small but significant effect in favour of NSAIDs compared to placebo for short-term pain reduction and global improvement in participants with acute LBP. This is an update of the previous review, focusing on acute LBP.

Objectives: To assess the effects of NSAIDs compared to placebo and other comparison treatments for acute LBP.

Search methods: We searched CENTRAL, MEDLINE, Embase, PubMed, and two trials registers for randomised controlled trials (RCT) to 7 January 2020. We also screened the reference lists from relevant reviews and included studies.

Selection criteria: We included RCTs that assessed the use of one or more types of NSAIDs compared to placebo (the main comparison) or alternative treatments for acute LBP in adults (≥ 18 years); conducted in both primary and secondary care settings. We assessed the effects of treatment on pain reduction, disability, global improvement, adverse events, and return to work.

Data collection and analysis: Two review authors independently selected trials to be included in this review, evaluated the risk of bias, and extracted the data. If appropriate, we performed a meta-analysis, using a random-effects model throughout, due to expected variability between studies. We assessed the quality of the evidence using the GRADE approach. We used standard methodological procedures recommended by Cochrane.

Main results: We included 32 trials, with a total of 5356 participants (age range 16 to 78 years). Follow-up ranged from one day to six months. Studies were conducted across the globe, the majority taking place in Europe and North-America. Africa and the Eastern Mediterranean region were not represented. We considered seven studies at low risk of bias. Performance and attrition were the most common biases. There was often a lack of information on randomisation procedures and allocation concealment (selection bias); studies were prone to selective reporting bias, since most studies did not register their trials. Almost half of the studies were industry-funded. There is moderate quality evidence that NSAIDs are slightly more effective in short-term (≤ 3 weeks) reduction of pain intensity (visual analogue scale (VAS), 0 to 100) than placebo (mean difference (MD) -7.29 (95% confidence interval (CI) -10.98 to -3.61; 4 RCTs, N = 815). There is high quality evidence that NSAIDs are slightly more effective for short-term improvement in disability (Roland Morris Disability Questionnaire (RMDQ), 0 to 24) than placebo (MD -2.02, 95% CI -2.89 to -1.15; 2 RCTs, N = 471). The magnitude of these effects is small and probably not clinically relevant. There is low quality evidence that NSAIDs are slightly more effective for short-term global improvement than placebo (risk ratio (RR) 1.40, 95% CI 1.12 to 1.75; 5 RCTs, N = 1201), but there was substantial heterogeneity (I² 52%) between studies. There is very low quality evidence of no clear difference in the proportion of participants experiencing adverse events when using NSAIDs compared to placebo (RR 0.86, 95% CI 0.63 to 1.18; 6 RCTs, N = 1394). There is very low quality evidence of no clear difference between the proportion of participants who could return to work after seven days between those who used NSAIDs and those who used placebo (RR 1.48, 95% CI 0.98 to 2.23; 1 RCT, N = 266). There is low quality evidence of no clear difference in short-term reduction of pain intensity between those who took selective COX-2 inhibitor NSAIDs compared to non-selective NSAIDs (mean change from baseline -2.60, 95% CI -9.23 to 4.03; 2 RCTs, N = 437). There is moderate quality evidence of conflicting results for short-term disability improvement between groups (2 RCTs, N = 437). Low quality evidence from one trial (N = 333) reported no clear difference between groups in the proportion of participants experiencing global improvement. There is very low quality evidence of no clear difference in the proportion of participants experiencing adverse events between those who took COX-2 inhibitors and non-selective NSAIDs (RR 0.97, 95% CI 0.63 to 1.50; 2 RCTs, N = 444). No data were reported for return to work.

Authors' conclusions: This updated Cochrane Review included 32 trials to evaluate the efficacy of NSAIDs in people with acute LBP. The quality of the evidence ranged from high to very low, thus further research is (very) likely to have an important impact on our confidence in the estimates of effect, and may change the estimates. NSAIDs seemed slightly more effective than placebo for short-term pain reduction (moderate certainty), disability (high certainty), and global improvement (low certainty), but the magnitude of the effects is small and probably not clinically relevant. There was no clear difference in short-term pain reduction (low certainty) when comparing selective COX-2 inhibitors to non-selective NSAIDs. We found very low evidence of no clear difference in the proportion of participants experiencing adverse events in both the comparison of NSAIDs versus placebo and selective COX-2 inhibitors versus non-selective NSAIDs. We were unable to draw conclusions about adverse events and the safety of NSAIDs for longer-term use, since we only included RCTs with a primary focus on short-term use of NSAIDs and a short follow-up. These are not optimal for answering questions about longer-term or rare adverse events.

Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Conflict of interest statement

Wendelien H van der Gaag has no known conflicts of interest.

Pepijn DDM Roelofs has no known conflicts of interest.

Wendy TM Enthoven has no known conflicts of interest.

Maurits W van Tulder was one of the Co‐ordinating Editors of the Cochrane Back and Neck Group and is currently on the Editorial Board. Editorial Board members are required to author reviews to remain current in methods. During the last three years, he has received research funding from the Netherlands Organisation for Health Research and Development, and the Dutch Health Insurance Council to his institution; and his institution received travel, accommodation, and meeting expenses from the European Pain Federation EFIC, and the Danish Occupational Therapy Association.

Bart W Koes has no known conflicts of interest.

Figures

1

1

Study flow diagram

2

2

'Risk of bias' summary per domain: review authors' judgements about each 'Risk of bias' item for each included study

3

3

'Risk of bias' graph per domain: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies

4

4

Forest plot of comparison: 1 NSAIDs versus placebo, outcome: 1.1 Pain intensity on 100‐mm VAS. Follow‐up ≤ 3 weeks.

5

5

Forest plot of comparison: 1 NSAIDs versus placebo, outcome: 1.2 Disability (RMDQ 0 to 24). Follow‐up ≤ 3 weeks.

6

6

Forest plot of comparison: 1 NSAIDs versus placebo, outcome: 1.3 Proportion of participants experiencing global improvement. Follow‐up ≤ 3 weeks.

1.1

1.1. Analysis

Comparison 1 NSAIDs versus placebo, Outcome 1 Pain Intensity on 100‐mm VAS. Follow‐up ≤ 3 weeks.

1.2

1.2. Analysis

Comparison 1 NSAIDs versus placebo, Outcome 2 Disability (RMDQ 0 to 24). Follow‐up ≤ 3 weeks.

1.3

1.3. Analysis

Comparison 1 NSAIDs versus placebo, Outcome 3 Proportion of participants experiencing global improvement. Follow‐up ≤ 3 weeks.

1.4

1.4. Analysis

Comparison 1 NSAIDs versus placebo, Outcome 4 Proportion of participants experiencing adverse events.

2.1

2.1. Analysis

Comparison 2 Selective COX‐2 inhibitors versus non‐selective NSAIDs, Outcome 1 Change in pain intensity from baseline on 100 mm VAS. Follow‐up ≤ 3 weeks.

2.2

2.2. Analysis

Comparison 2 Selective COX‐2 inhibitors versus non‐selective NSAIDs, Outcome 2 Proportion of patients experiencing adverse events.

2.3

2.3. Analysis

Comparison 2 Selective COX‐2 inhibitors versus non‐selective NSAIDs, Outcome 3 Proportion of patients experiencing gastrointestinal adverse events.

3.1

3.1. Analysis

Comparison 3 NSAIDs versus paracetamol, Outcome 1 Mean difference in pain intensity on various scales. Follow‐up ≤ 3 weeks.

3.2

3.2. Analysis

Comparison 3 NSAIDs versus paracetamol, Outcome 2 Proportion of participants experiencing adverse events.

4.1

4.1. Analysis

Comparison 4 NSAIDs versus other drug treatment, Outcome 1 Proportion of participants experiencing global improvement. Follow‐up ≤ 3 weeks.

4.2

4.2. Analysis

Comparison 4 NSAIDs versus other drug treatment, Outcome 2 Proportion of participants experiencing adverse events.

5.1

5.1. Analysis

Comparison 5 NSAIDs versus non‐drug treatment, Outcome 1 Pain Intensity on 100‐mm VAS. Follow‐up ≤ 3 weeks..

5.2

5.2. Analysis

Comparison 5 NSAIDs versus non‐drug treatment, Outcome 2 Proportion of participants experiencing global improvement. Follow‐up ≤ 3 weeks.

5.3

5.3. Analysis

Comparison 5 NSAIDs versus non‐drug treatment, Outcome 3 Proportion of participants experiencing adverse events.

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References

References to studies included in this review

Aghababian 1986 {published data only}
    1. Aghababian RV, Volturo GA, Heifetz IN. Comparison of diflunisal and naproxen in the management of acute low back pain. Clinical Therapeutics 1986;9(Suppl C):47‐51. - PubMed
Agrifoglio 1994 {published data only}
    1. Agrifoglio E, Benvenutti M, Gatto P, Albanese L, Chrubino P, Marinoni EC, et al. Aceclofenac: a new NSAID in the treatment of acute lumbago. Multicentre single blind study vs. diclofenac. Acta Therapeutica 1994;20:33‐43.
Amlie 1987 {published data only}
    1. Amlie E, Weber H, Holme I. Treatment of acute low back pain with piroxicam: results of a double‐blind placebo‐controlled trial. Spine 1987;12:473‐6. - PubMed
Babej‐Dolle 1994 {published data only}
    1. Babej‐Dolle R, Freytag S, Eckmeyer J, Zerle G, Schinzel S, Schmeider G, et al. Parenteral dipyrone versus diclofenac and placebo in patients with acute lumbago or sciatic pain: randomized observer‐blind multicenter study. International Journal of Clinical Pharmacology and Therapeutics 1994;32:204‐9. - PubMed
Bakshi 1994 {published data only}
    1. Bakshi R, Thumb N, Bröll H, Klein G, Mayrhofer F, Rainer F, et al. Treatment of acute lumbosacral back pain with diclofenac resinate: results of a double‐blind comparative trial versus piroxicam. Drug Investigation 1994;8:288‐93.
Brown 1986 {published data only}
    1. Brown FL, Bodison S, Dixon J, Davis W, Nowoslawski J. Comparison of diflunisal and acetaminophen with codeine in the treatment of initial or recurrent acute low back pain. Clinical Therapeutics 1986;9(Suppl C):52‐8. - PubMed
Colberg 1996 {published data only}
    1. Colberg K, Hettich M, Sigmund R, Degner FL. The efficacy and tolerability of an 8‐day administration of intravenous and oral meloxicam: a comparison with intramuscular and oral diclofenac in patients with acute lumbago. German Meloxicam Ampoule Study Group. Current Medical Research and Opinion 1996;13:363‐77. - PubMed
Dreiser 2003 {published data only}
    1. Dreiser RL, Marty M, Ionescu E, Gold M, Liu JH. Relief of acute low back pain with diclofenac‐K 12.5 mg tablets: a flexible dose, ibuprofen 200 mg and placebo‐controlled clinical trial. International Journal of Clinical Pharmacy and Therapeutics 2003;41(9):375‐85. - PubMed
Hancock 2007 {published and unpublished data}
    1. Hancock MJ, Maher CG, Latimer J, McLachlan AJ, Cooper CW, Day RO, et al. Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first‐line treatment for acute low back pain: a randomised controlled trial. Lancet 2007;370(9599):1638‐43. - PubMed
    1. Hancock MJ, Maher CG, Latimer J, et al. Manipulative therapy and/or NSAIDs for acute low back pain: design of a randomized controlled trial [ACTRN012605000036617]. BMC Musculoskel Dis 2005; 6: 57. 2005;6:57. - PMC - PubMed
Hosie 1993 {published data only}
    1. Hosie GAC. The topical NSAID, felbinac, versus oral ibuprofen: a comparison of efficacy in the treatment of acute lower back injury. British Journal of Clinical Research 1993;4:5‐17.
Innes 1998 {published data only}
    1. Innes GD, Croskerry P, Worthington J, Beveridge R, Jones D. Ketorolac versus acetaminophen‐codeine in the emergency department treatment of acute low back pain. Journal of Emergency Medicine 1998;16(4):549‐56. - PubMed
Jaffe 1974 {published data only}
    1. Jaffe G. A double‐blind, between‐patient comparison of alclofenac ('Prinalgin' ) and indomethacin in the treatment of low back pain and sciatica. Current Medical Research and Opinion 1974;2:424‐9. - PubMed
Lacey 1984 {published data only}
    1. Lacey PH, Dodd GD, Shannon DJ. A double‐blind placebo controlled study of piroxicam in the management of acute musculoskeletal disorders. European Journal of Rheumatology and Inflammation 1984;7:95‐104. - PubMed
Metscher 2001 {published data only}
    1. Metscher B. Kubler U. Jahnel‐Kracht H. Dexketoprofen‐trometamol and tramadol in acute lumbago [Dexketoprofen‐Trometamol und Tramadol bei akuter Lumbago]. Fortschritte der Medizin. Originalien 2001;118(4):147‐51. - PubMed
Miki 2018 {published and unpublished data}
    1. Miki K, Ikemoto T, Hayashi K, Arai Y, Sekiguchi M, Shi K, et al. Randomized open‐label non‐inferiority trial of acetaminophen or loxoprofen for patients with acute low back pain. Journal of Orthopaedic Science 2018 Oct 3;23(3):483‐7. [PUBMED: PMID: 30292383] - PubMed
Nadler 2002 {published data only}
    1. Nadler SF, Steiner DJ, Erasala GN, Hengehold DA, Hinkle RT, Beth Goodale M, et al. Continuous low‐level heat wrap therapy provides more efficacy than Ibuprofen and acetaminophen for acute low back pain. Spine 2002;27(10):1012‐7. - PubMed
Orava 1986 {published data only}
    1. Orava S. Medical treatment of acute low back pain. Diflunisal compared with indomethacin in acute lumbago. International Journal of Clinical Research 1986;6:45‐51. - PubMed
Plapler 2016 {published data only}
    1. Plapler PG, Scheinberg MA, Ecclissato CC, Bocchi de Oliveira MF, Amazonas RB. Double‐blind, randomized, double‐dummy clinical trial comparing the efficacy of ketorolac trometamol and naproxen for acute low back pain. Drug Design, Development and Therapy 2016;10:1987‐93. - PMC - PubMed
Pohjolainen 2000 {published data only}
    1. Pohjolainen T, Jekunen A, Autio L, Vuorela H. Treatment of acute low back pain with the COX‐2‐selective anti‐inflammatory drug nimesulide: results of a randomized, double‐blind comparative trial versus ibuprofen. Spine 2000;25(12):1579‐85. - PubMed
Postacchini 1988 {published data only}
    1. Postacchini F, Facchini M, Palieri P. Efficacy of various forms of conservative treatment in low back pain: a comparative study. Neuro‐Orthopedics 1988;6:28‐35.
Schattenkirchner 2003 {published data only}
    1. Schattenkirchner M, Milachowski KA. A double‐blind, multicentre, randomised clinical trial comparing the efficacy and tolerability of aceclofenac with diclofenac resinate in patients with acute low back pain. Clinical Rheumatology 2003;22(2):127‐35. - PubMed
Shin 2013 {published data only}
    1. Shin JS, Ha IH, Lee J, Choi Y, Kim MR, Park BY, et al. Effects of motion style acupuncture treatment in acute low back pain patients with severe disability: a multicenter, randomized, controlled, comparative effectiveness trial. Pain 2013;154(7):1030‐7. - PubMed
    1. Shin JS, Ha IH, Lee TG, Choi Y, Park BY, Kim MR, Lee MS. Motion style acupuncture treatment (MSAT) for acute low back pain with severe disability: a multicenter, randomized, controlled trial protocol. BMC Complement Altern Med 2011;11:127. - PMC - PubMed
Stratz 1990 {published data only}
    1. Stratz T. Intramuscular etofenamate in the treatment of acute lumbago. Effectiveness and tolerance in comparison with intramuscular diclofenac‐Na. Fortschritte der Medizin 1990;108:264‐6. - PubMed
Szpalski 1990 {published data only}
    1. Szpalski M, Poty S, Hayez JP, Debaize JP. Objective assessment of trunk function in patients with acute low back pain treated with Tenoxicam. A prospective controlled study. Neuro‐orthopedics 1990;10:41‐7.
Szpalski 1994 {published data only}
    1. Szpalski M, Hayez JP. Objective functional assessment of the efficacy of tenoxicam in the treatment of acute low back pain: a double blind placebo‐controlled study. British Journal of Rheumatology 1994;33:74‐8. - PubMed
Videman 1984 {published data only}
    1. Videman T, Heikkila J, Partanen T. Double‐blind parallel study of meptazinol versus diflunisal in the treatment of lumbago. Current Medical Research and Opinion 1984;9:246‐52. - PubMed
von Heymann 2013 {published data only}
    1. Heymann WJ, Schloemer P, Timm J, Muehlbauer B. Spinal high‐velocity low amplitude manipulation in acute nonspecific low back pain: a double‐blinded randomized controlled trial in comparison with diclofenac and placebo. Spine 2013;38(7):540‐8. [DOI: 10.1097/BRS.0b013e318275d09c] - DOI - PubMed
Waterworth 1985 {published data only}
    1. Waterworth RF, Hunter IA. An open study of diflunisal, conservative and manipulative therapy in the management of acute mechanical low back pain. New Zealand Medical Journal 1985;May:372‐5. - PubMed
Wiesel 1980 {published data only}
    1. Wiesel SW, Cuckler JM, Deluca F, Jones F, Zeide MS, Rothman RH. Acute low back pain: an objective analysis of conservative therapy. Spine 1980;5:324‐30. - PubMed
Ximenes 2007 {published data only}
    1. Ximenes A, Robles M, Sands G, Vinueza R. Valdecoxib is as efficacious as diclofenac in the treatment of acute low back pain. Clinical Journal of Pain 2007;23(3):244‐50. - PubMed
Yakhno 2006 {published data only}
    1. Yakhno N, Guekht A, Skoromets A, Spirin N, Strachunskaya E, Ternavsky A, et al. Analgesic efficacy and safety of lornoxicam quick‐release formulation compared with diclofenac potassium: Randomised, double‐blind trial in acute low back pain. Clinical Drug Investigation 2006;26(5):267‐77. - PubMed
Zippel 2007 {published data only}
    1. Zippel H, Wagenitz A. A multicentre, randomised, double‐blind study comparing the efficacy and tolerability of intramuscular dexketoprofen versus diclofenac in the symptomatic treatment of acute low back pain.. Clinical Drug Investigation 2007;27(8):533‐43. - PubMed

References to studies excluded from this review

Allegrini 2009 {published data only}
    1. Allegrini A, Nuzzo L, Pavone D, Tavella‐Scaringi A, Giangreco D, Bucci M, et al. Efficacy and safety of piroxicam patch versus piroxicam cream in patients with lumbar osteoarthritis: A randomized, placebo‐controlled study. Arzneimittel‐Forschung/Drug Research 2009;59(8):403‐9. - PubMed
Altan 2019 {published data only}
    1. Altan L, Kasapoglu Aksoy M, Kösegil Öztürk E. Efficacy of diclofenac & thiocolchioside gel phonophoresis comparison with ultrasound therapy on acute low back pain; a prospective, double‐blind, randomized clinical study. Ultrasonics 2019 Jan;91:201‐5. - PubMed
Anaya 2014 {published data only}
    1. Anaya A, Plantmason L, Dhaliwal G. Back attack. Journal of General Internal Medicine 2014;29(1):255‐9. - PMC - PubMed
Arul Prakasam 2011 {published data only}
    1. Arul Prakasam KC, Salman P, Senthilkumar N. Comparative assessment of analgesic effect of different NSAID's in the management of low back pain. International Journal of PharmTech Research 2011;3(3):1260‐4.
Berry 1988 {published data only}
    1. Berry H, Hutchinson DR. Tizanidine and ibuprofen in acute low‐back pain: results of a double‐blind multicentre study in general practice. Journal of International Medical Research 1988;16:83‐91. - PubMed
Blazek 1986 {published data only}
    1. Blazek M, Keszthelyi B, Varhelyi M, Korosi O. Comparative study of biarison and voltaren in acute lumbar pain and lumbo‐ischialgia. Therapia Hungarica (English Edition) 1986;34:163‐6. - PubMed
Borenstein 1990 {published data only}
    1. Borenstein DG, Lacks S, Wiesel SW. Cyclobenzaprine and naproxen versus naproxen alone in the treatment of acute low back pain and muscle spasm. Clinical Therapeutics 1990;12:125‐31. - PubMed
Bruggemann 1990 {published data only}
    1. Bruggemann G, Koehler CO, Koch EM. Results of a double‐blind study of diclofenac + vitamin B1, B6, B12 versus diclofenac in patients with acute pain of the lumbar vertebrae. A multicenter study. Klinische Wochenschrift 1990;68:116‐20. - PubMed
Buchbinder 2010 {published data only}
    1. Buchbinder R. Topical NSAIDs provide effective relief of acute musculoskeletal pain compared to placebo, with no increase in risk of adverse effects. Evidence‐Based Medicine 2010;15(6):177‐8. - PubMed
Chrubasik 2003 {published data only}
    1. Chrubasik S, Model A, Black A, Pollak S. A randomized double‐blind pilot study comparing Doloteffin and Vioxx in the treatment of low back pain. Rheumatology (Oxford) 2003;42(1):141‐8. - PubMed
Coats 2004 {published data only}
    1. Coats TL, Borenstein DG, Nangia NK, Brown MT. Effects of valdecoxib in the treatment of chronic low back pain: results of a randomized, placebo‐controlled trial. Clinical Therapeutics 2004;26(8):1249‐60. - PubMed
Cohen 2017 {published data only}
    1. Cohen MM, Smit V, Andrianopoulos N, Ben‐Meir M, Taylor DM, Parker SJ, et al. Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial. Medical Journal of Australia 2017;206(11):494‐9. - PubMed
Costantino 2011 {published data only}
    1. Costantino C, Marangio E, Coruzzi G. Mesotherapy versus systemic therapy in the treatment of acute low back pain: a randomized trial. Evidence‐Based Complementary and Alternative Medicine: eCAM 2011;2011:317183. - PMC - PubMed
Day 2013 {published data only}
    1. Day RO, Graham GG. Therapeutics: non‐steroidal anti‐inflammatory drugs (NSAIDs). BMJ (Online) 2013;346:f3195. [DOI: 10.1136/bmj.f3195] - DOI - PubMed
Dehghan 2014 {published data only}
    1. Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. Journal of Clinical and Diagnostic Research 2014;8(9):LC01‐4. - PMC - PubMed
Dehghan 2015 {published data only}
    1. Dehghan M, Farahbod F. Evaluation of the therapeutic effect of oral gabapentin on the severity of acute low back pain [Persian]. Scientific Journal of Kurdistan University of Medical Sciences 2015;20(1):97‐104.
Driessens 1994 {published data only}
    1. Driessens M, Famaey JP, Orloff S, Chochrad I, Cleppe D, Brabanter G, et al. Efficacy and tolerability of sustained‐release ibuprofen in the treatment of patients with chronic back pain. Current Therapeutic Research, Clinical and Experimental 1994;55:1283‐92.
Eken 2014 {published data only}
    1. Eken C, Serinken M, Elicabuk H, Uyanik E, Erdal M. Intravenous paracetamol versus dexketoprofen versus morphine in acute mechanical low back pain in the emergency department: a randomised double‐blind controlled trial. Emergency Medicine Journal 2014;31(3):177‐81. - PubMed
Evans 1980 {published data only}
    1. Evans DP, Burke MS, Newcombe RG. Medicines of choice in low back pain. Current Medical Research and Opinion 1980;6:540‐7. - PubMed
Friedman 2015 {published data only}
    1. Friedman BW, Dym AA, Davitt M, Holden L, Solorzano C, Esses D, et al. Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA 2015;314(15):1572‐80. [DOI: 10.1001/jama.2015.13043] - DOI - PubMed
Friedman 2016 {published data only}
    1. Friedman BW, Irizarry E, Solorzano C, Khankel N, Zapata J, Zias E, et al. Diazepam is no better than placebo when added to naproxen for acute low back pain. Annals of Emergency Medicine 2017 Aug;70(2):169‐76. [DOI: 10.1016/j.annemergmed.2016.10.002] - DOI - PMC - PubMed
Friedman 2018 {published data only}
    1. Friedman BW, Cisewski D, Irizarry E, Davitt M, Solorzano C, Nassery A, et al. A randomized, double‐blind, placebo‐controlled trial of Naproxen with or without Orphenadrine or Methocarbamol for acute low back pain. Annals of Emergency Medicine 2018;71(3):348‐56. - PMC - PubMed
Geller 2016 {published data only}
    1. Geller M, Mibielli MA, Nunes CP, Fonseca AS, Goldberg SW, Oliveira L. Comparison of the action of diclofenac alone versus diclofenac plus B vitamins on mobility in patients with low back pain. Journal of Drug Assessment 2016;5(1):1‐3. - PMC - PubMed
Górska 2005 {published data only}
    1. Górska J. Effects of back pain treatment with tizanidine [Polish]. Ortopedia, Traumatologia, Rehabilitacja 2005;7(3):306‐9. - PubMed
Ilic 2009 {published data only}
    1. Ilic KV, Sefik‐Bukilica M, Jankovic S, Vujasinovic‐Stupar N. Efficacy and safety of two generic copies of nimesulide in patients with low back pain or knee osteoarthritis. Reumatismo 2009;61(1):27‐33. - PubMed
Ingpen 1969 {published data only}
    1. Ingpen ML. A controlled clinical trial of sustained‐action dextropropoxyphene hydrochloride. British Journal of Clinical Practice 1969;23:113‐5. - PubMed
IRCT2013052213146N2 {published data only}
    1. IRCT2013052213146N2. Compare between non‐steroidal anti‐inflammatory drugs and different frequencies of pulse low level laser therapy in acute low back pain. en.irct.ir/trial/13065 (first registered 15 December 2013).
Kuhlwein 1990 {published data only}
    1. Kuhlwein A, Meyer HJ, Koehler CO. Reduced diclofenac administration by B vitamins: results of a randomized double‐blind study with reduced daily doses of diclofenac (75 mg diclofenac versus 75 mg diclofenac plus B vitamins) in acute lumbar vertebral syndromes. Klinische Wochenschrift 1990;68:107‐15. - PubMed
Lee 2008 {published data only}
    1. Lee HKH, Ting SM, Lau FL. A randomised control trial comparing the efficacy of tramadol and paracetamol against ketorolac and paracetamol in the management of musculoskeletal pain in the emergency department. Hong Kong Journal of Emergency Medicine. January 2008;15(1):5‐11.
Listrat 1990 {published data only}
    1. Listrat V, Dougados M, Chevalier X, Kramer F, Amor B. Comparison of the analgesic effect of tenoxicam after oral or intramuscular administration. Drug Investigation 1990;2(Suppl 3):51‐2. [DOI: 10.1007/BF03258217] - DOI
Matsumo 1981 {published data only}
    1. Matsumo S, Kaneda K, Nohara Y. Clinical evaluation of Ketoprofen (Orudis) in lumbago: a double‐blind comparison with diclofenac sodium. British Journal of Clinical Practice 1981;35(7‐8):266. [PUBMED: PMID 6459111] - PubMed
Muckle 1986 {published data only}
    1. Muckle DS. Flurbiprofen for the treatment of soft tissue trauma. American Journal of Medicine 1986;80:76‐80. - PubMed
Ostojic 2017 {published data only}
    1. Ostojic P, Radunovic G, Lazovic M, Tomanovic‐Vujadinovic S. Ibuprofen plus paracetamol versus ibuprofen in acute low back pain: a randomized open label multicenter clinical study. Acta Reumatologica Portuguesa 2017;42(1):18‐25. - PubMed
Pena 1990 {published data only}
    1. Pena M. Etodolac: analgesic effects in musculoskeletal and postoperative pain. Rheumatology International 1990;10(Suppl):9‐16. - PubMed
Schreijenberg 2017 {published data only}
    1. Schreijenberg M, Luijsterburg PA, Trier YD, Rizopoulos D, Koopmanschap MA, Voogt L, et al. Efficacy of paracetamol, diclofenac and advice for acute low back pain in general practice: design of a randomized controlled trial (PACE Plus). BMC Musculoskeletal Disorders 2017;18(1):56. - PMC - PubMed
Serinken 2016 {published data only}
    1. Serinken M, Eken C, Tunay K, Golcuk Y. Ketoprofen gel improves low back pain in addition to IV dexketoprofen: a randomized placebo‐controlled trial. American Journal of Emergency Medicine 2016;34(8):1458‐61. - PubMed
Shell 2012 {published data only}
    1. Shell WE, Charuvastra EH, Dewood MA, May LA, Bullias DH, Silver DS. A double‐blind controlled trial of a single dose naproxen and an amino acid medical food theramine for the treatment of low back pain. American Journal of Therapeutics 2012;19(2):108‐14. - PubMed
Shikhkerimov 2016 {published data only}
    1. Shikherimov RK. The use of nimesulide in the treatment of acute low back pain [Russian] [Применение нимесулида в терапии острой боли в нижней частиспины]. Zhurnal Nevrologii i Psikhiatrii Imeni S S 2016;116(5):28‐32. - PubMed
Siegmeth 1978 {published data only}
    1. Siegmeth W, Sieberer W. A comparison of the short‐term effects of ibuprofen and diclofenac in spondylosis. Journal of International Medical Research 1978;6:369‐74. - PubMed
Stark 2014 {published data only}
    1. Stark J, Petrofsky J, Berk L, Bains G, Chen S, Doyle G. Continuous low‐level heat wrap therapy relieves low back pain and reduces muscle stiffness.. Physician & Sportsmedicine 2014;42(4):39‐48. - PubMed
Vetter 1988 {published data only}
    1. Vetter G, Bruggemann G, Lettko M, Schwieger G, Asbach H, Biermann W, et al. Shortening diclofenac therapy by B vitamins. Results of a randomized double‐blind study, diclofenac 50 mg versus diclofenac 50 mg plus B vitamins, in painful spinal diseases with degenerative changes. Zeitschrift fur Rheumatologie 1988;47:351‐62. - PubMed
Voicu 2019 {published data only}
    1. Voicu VA, Mircioiu C, Plesa C, Jinga M, Balaban V, Sandulovici R, et al. Effect of a new synergistic combination of low doses of acetylsalicylic acid, caffeine, acetaminophen, and chlorpheniramine in acute low back pain. Frontiers in Pharmacology 2019;10:607. - PMC - PubMed
von Uberall 2013 {published data only}
    1. Uberall MA, Essner U, Muller‐Schwefe GH. 2‐week efficacy and tolerability of flupirtine MR and diclofenac in patients with acute low/back pain – results of a post‐hoc subgroup analysis of patient‐level data from four non‐interventional studies [German] [2‐Wochen‐Wirksamkeit und ‐Verträglichkeit von Flupirtin MR und Diclofenac bei akuten Kreuz‐/Rückenschmerzen]. MMW Fortschritte der Medizin 2013 Dec;155 Suppl 4:115‐23. - PubMed
Yastrebov 2012 {published data only}
    1. Yastrebov DN, Shpagin MV, Artifexo SB. Pathophysiological substantiation of epidural administration of Tenoxicam in dorsalgia treatment. Sovremennye Tehnologii v Medicine 2012;1:133‐6.

References to studies awaiting assessment

Aoki 1983 {published data only}
    1. Aoki T, Kuroki Y, Kageyama T, Irimajiri S, Mizushima Y, Yamamoto K. Multicentre double‐blind comparison of piroxicam and indomethacin in the treatment of lumbar diseases. European Journal of Rheumatology and Inflammation 1983;6:247‐52. - PubMed
Basmajian 1989 {published data only}
    1. Basmajian JV. Acute back pain and spasm: a controlled multicenter trial of combined analgesic and antispasm agents. Spine 1989;14:438‐9. - PubMed
Borghi 2018 {published data only}
    1. Borghi B, Aurini L, White PF, Tognù A, Rossi B, Fini G, et al. Treatment of recent onset low back pain with periradicular injections of meloxicam: a randomized, double blind, placebo controlled cross‐over study. Minerva Anestesiologica 2018 May;84(5):590‐8. - PubMed
Davoli 1989 {published data only}
    1. Davoli L, Ciotti G, Biondi M, Passeri M. Piroxicam‐beta‐cyclodextrin in the treatment of low‐back pain. Controlled study vs etodolac. Current Therapeutic Research, Clinical and Experimental 1989;46:940‐7.
Famaey 1998 {published data only}
    1. Famaey JP, Bruhwyler J, Geczy J, Vandekerckhove K, Appelboom T. Open controlled randomized multicenter comparison of nimesulide and diclofenac in the treatment of subacute and chronic low back pain. Journal of Clinical Research 1998;1:219‐38.
Hingorani 1970 {published data only}
    1. Hingorani K, Biswas AK. Double‐blind controlled trial comparing oxyphenbutazone and indomethacin in the treatment of acute low back pain. British Journal of Clinical Practice 1970;24:120‐3. - PubMed
Hingorani 1975 {published data only}
    1. Hingorani K, Templeton JS. A comparative trial of azapropazone and ketoprofen in the treatment of acute backache. Current Medical Research and Opinion 1975;3:407‐12. - PubMed
Jacobs 1968 {published data only}
    1. Jacobs JH, Grayson MF. Trial of anti‐inflammatory agent (indomethacin) in low back pain with and without radicular involvement. British Medical Journal 1968;3:158‐60. - PMC - PubMed
Milgrom 1993 {published data only}
    1. Milgrom C, Finestone A, Lev B, Wiener M, Floman Y. Overexertional lumbar and thoracic back pain among recruits: a prospective study of risk factors and treatment regimens. Journal of Speech Disorders 1993;6:187‐93. - PubMed
NCT01374269 {published data only}
    1. NCT01374269. Improvement in pain, function and HRQoL (Health Related Quality of Life) in subacute low back pain: a controlled clinical trial of exercise versus NSAIDs. clinicaltrials.gov/ct2/show/study/NCT01374269 (first posted 15 June 2011).
Predel 2019 {published data only}
    1. Predel HG, Ebel‐Bitoun C, Lange R, Weiser T. A randomized, placebo‐ and active‐controlled, multi‐country, multi‐center parallel group trial to evaluate the efficacy and safety of a fixed‐dose combination of 400 mg ibuprofen and 100 mg caffeine compared with ibuprofen 400 mg and placebo in patients with acute lower back or neck pain. Journal of Pain Research 2019;12:2771‐83. - PMC - PubMed
Sweetman 1987 {published data only}
    1. Sweetman BJ, Baig A, Parsons DL. Mefenamic acid, chlormezanone‐paracetamol, ethoheptazine‐aaspirin‐meprobamate: a comparative study in acute low back pain. British Journal of Clinical Practice 1987;41:619‐24. - PubMed
TCTR20141027001 {published data only}
    1. TCTR20141027001. A single‐blind randomized controlled trial of AVS023 poly‐herbal formula for Acute low back pain: a pilot study. apps.who.int/trialsearch/Trial2.aspx?TrialID=TCTR20141027001 (first registered 27 October 2014).
Waikakul 1995 {published data only}
    1. Waikakul S, Soparat K. Effectiveness and safety of loxoprofen compared with naproxen in nonsurgical low back pain: a parallel study. Clinical Drug Investigation 1995;10:59‐63.
Waikakul 1996 {published data only}
    1. Waikakul S, Danputipong P, Soparat K. Topical analgesics, indomethacin plaster and diclofenac emulgel for low back pain: a parallel study. Journal of the Medical Association of Thailand 1996;79:486‐90. - PubMed
Zolotovskaya 2015 {published data only}
    1. Zolotovskaya IA, Davydkin IL. Effect of nonsteroidal anti‐inflammatory drugs on the indicators of cardiovascular risk in patients with acute nonspecific back pain [Russian]. Terapevticheskii Arkhiv 2015;87(12):18‐25. - PubMed

References to ongoing studies

CTRI/2018/11/016371 {published data only}
    1. CTRI/2018/11/016371. A comparative study of the efficacy and tolerability of fixed dose combination of etoricoxib and thiocolchicoside and thiocolchicoside alone in patients with painful muscle spasm. apps.who.int/trialsearch/Trial2.aspx?TrialID=CTRI/2018/11/016371 (first registered 16 November 2018 ).
NCT03861611 {published data only}
    1. NCT03861611. A comparison of NSAIDs for acute, non‐radicular low back pain. A randomized trial. clinicaltrials.gov/ct2/show/NCT03861611 (first posted 4 March 2019).
NCT04111315 {published data only}
    1. NCT04111315. Efficacy of metamizole versus ibuprofen and a short educational intervention versus standard care in acute and subacute low back pain: a randomized, factorial trial. clinicaltrials.gov/ct2/show/NCT04111315 (first posted 1 October 2019).
TCTR20151118003 {published data only}
    1. TCTR20151118003. Efficacy of Ayurved SIRIRAJ SAHATTHARA recipe, in patient with acute low back pain, the open‐label randomized controlled trial. apps.who.int/trialsearch/Trial2.aspx?TrialID=TCTR20151118003 (first registered 17 November 2015).

Additional references

Bernstein 2017
    1. Bernstein IA, Malik Q, Carville S, Ward S. Low back pain and sciatica: summary of NICE guidance. BMJ 2017;356:i6748. [DOI: 10.1136/bmj.i6748] - DOI - PubMed
Boutron 2005
    1. Boutron I, Moher D, Tugwell P, Giraudeau B, Poiraudeau S, Nizard R, et al. A checklist to evaluate a report of a non pharmacological trial (CLEAR NPT) was developed using consensus. Journal of Clinical Epidemiology 2005;58:1233‐40. - PubMed
Brune 2015
    1. Brune K, Patrignani P. New insights into the use of currently available non‐steroidal anti‐inflammatory drugs. Journal of Pain Research 2015;8:105‐18. [DOI: 10.2147/JPR.S75160] - DOI - PMC - PubMed
Chiarotto 2018
    1. Chiarotto A, Boers M, Deyo RA, Buchbinder R, Corbin TP, Costa LOP, et al. Core outcome measurement instruments for clinical trials in non‐specific low back pain. Pain 2018;159(3):481–95. [DOI: 10.1097/j.pain.0000000000001117; PUBMED: 29194127] - DOI - PMC - PubMed
CNT Collaboration 2013
    1. Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA, et al. Coxib and traditional NSAID Trialists' (CNT) Collaboration. Vascular and upper gastrointestinal effects of non‐steroidal anti‐inflammatory drugs: meta‐analyses of individual participant data from randomised trials. Lancet 2013 Aug;382(9894):769‐79. [DOI: 10.1016/S0140-6736(13)60900-9; PUBMED: 23726390] - DOI - PMC - PubMed
Costa 2012
    1. Costa da LCM, Maher CG, Hancock, MJ, McAuley JH, Herbert RD, Costa LOP. The prognosis of acute and persistent low‐back pain: a meta‐analysis. Canadian Medical Association Journal 2012;184(11):E613‐2. [DOI: 10.1503/cmaj.111271] - DOI - PMC - PubMed
Deyo 2014
    1. Deyo RA, Dworkin SF, Amtmann D, Andersson G, Borenstein D, Carragee E, et al. Report of the NIH Task Force on research standards for chronic low back pain. Journal of Pain 2014 Jun;15(6):569‐85. [DOI: 10.1016/j.jpain.2014.03.005; PUBMED: 24787228] - DOI - PMC - PubMed
Enthoven 2016
    1. Enthoven WTM, Roelofs PDDM, Deyo RA, Tulder MW, Koes BW. Non‐steroidal anti‐inflammatory drugs for chronic low back pain. Cochrane Database of Systematic Reviews 2016, Issue 2. [DOI: 10.1002/14651858.CD012087] - DOI - PMC - PubMed
Furlan 2015
    1. Furlan AD, Malmivaara A, Chou R, Maher CG, Deyo RA, Schoene M, et al. Editorial Board of the Cochrane Back and Neck Group. 2015 Updated method guideline for systematic reviews in the Cochrane Back and Neck Group. Spine 2015;40(21):1660‐73. [DOI: 10.1097/BRS.0000000000001061; PUBMED: 26208232] - DOI - PubMed
GBD 2016
    1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390(10100):1211‐59. [DOI: 10.1016/S0140-6736(17)32154-2] - DOI - PMC - PubMed
GRADE Working Group 2004
    1. Atkins D, Best D, Briss PA, Eccles M, Falck‐Ytter Y, Flottorp S, et al. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ June 2004;328(7454):1490. - PMC - PubMed
GRADEpro GDT [Computer program]
    1. McMaster University (developed by Evidence Prime). GRADEpro GDT. Version accessed 31 January 2019. Hamilton (ON): McMaster University (developed by Evidence Prime).
Grosser 2011
    1. Grosser T, Smyth E, FitzGerald GA. Anti‐inflammatory, antipyretic, and analgesic agents; pharmacology of gout. In: Brunton LL, Chabner BA, Knollman BC editor(s). Goodman & Gilman's Pharmacological Basis of Therapeutics. 12th Edition. New York: McGraw‐Hill, 2011:962‐77.
Guyatt 2008
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924‐6. [DOI: 10.1136/bmj.39489.470347.AD] - DOI - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Hoy 2010
    1. Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Practice & Research Clinical Rheumatology 2010;24:769‐81. [DOI: 10.1016/j.berh.2010.10.002] - DOI - PubMed
Itz 2013
    1. Itz CJ, Geurts JW, Kleef M, Nelemans P. Clinical course of non‐specific low back pain: a systematic review of prospective cohort studies set in primary care.. European Journal of Pain (London, England) 2013 Jan;17(1):5‐15. [PUBMED: 22641374] - PubMed
Koes 2006
    1. Koes BW, Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ 2006 June 17;332(7555):1430‐4. [DOI: 10.1136/bmj.332.7555.1430; PUBMED: 16777886] - DOI - PMC - PubMed
Koes 2010
    1. Koes BW, Tulder MW, Lin CW, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non‐specific low back pain in primary care. European Spine Journal 2010 Dec;19(12):2075‐94. - PMC - PubMed
Lidgren 2003
    1. Lidgren L. The bone and joint decade 2000‐2010. Bulletin of the World Health Organization 2003;81(9):629. [PUBMED: PMC2572548] - PMC - PubMed
Lundh 2017
    1. Lundh A, Lexchin J, Mintzes B, Schroll JB, Bero L. Industry sponsorship and research outcome. Cochrane Database of Systematic Reviews 2017, Issue 2. [DOI: 10.1002/14651858.MR000033.pub3] - DOI - PMC - PubMed
Machado 2017
    1. Machado GC, Maher CG, Ferreira PH, Day RO, Pinheiro MB, Ferreira ML. Non‐steroidal anti‐inflammatory drugs for spinal pain: a systematic review and meta‐analysis. Annals of the Rheumatic Diseases 2017;76:1269‐78. [DOI: 10.1136/annrheumdis-2016-210597] - DOI - PubMed
Manchikanti 2014
    1. Manchikanti L, Singh V, Falco FJE, Ramsin M, Benyamin MD, Hirsch JA. Epidemiology of low back pain in adults. Neuromodulation: Technology at the Neural Interface 2014;17(52):3‐10. [DOI: 10.1111/ner.12018] - DOI - PubMed
Mueller 2007
    1. Mueller PS, Montori VM, Bassler D, Koenig BA, Guyatt GH. Ethical issues in stopping randomized trials early because of apparent benefit. Annals of Internal Medicine June 2007;146(12):878–81. [DOI: 10.7326/0003-4819-146-12-200706190-00009] - DOI - PubMed
Oliveira 2018
    1. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, et al. Clinical practice guidelines for the management of non‐specific low back pain in primary care: an updated overview. European Spine Journal 2018 Nov;27(11):2791‐2803. [DOI: 10.1007/s00586-018-5673-2] - DOI - PubMed
Ostelo 2008
    1. Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Korff M, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 2008 Jan 1;33(1):90‐4. [DOI: 10.1097/BRS.0b013e31815e3a10; PUBMED: 18165753] - DOI - PubMed
Pengel 2003
    1. Pengel LH, Herbert RD, Maher CG, Refshauge KM. Acute low back pain: systematic review of its prognosis. BMJ 2003 Aug 9;327(7410):323. [DOI: 10.1136/bmj.327.7410.323; PUBMED: 12907487] - DOI - PMC - PubMed
Pepine 2017
    1. Pepine CJ, Gurbel PA. Cardiovascular safety of NSAIDs: additional insights after PRECISION and point of view. Clinical Cardiology 2017 Dec;40(12):1352‐6. [DOI: 10.1002/clc.22814; PUBMED: 29247518] - DOI - PMC - PubMed
Qaseem 2017
    1. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine 2017;166:514‐30. [DOI: 10.7326/M16-2367] - DOI - PubMed
Rasmussen‐Barr 2016
    1. Rasmussen‐Barr E, Held U, Grooten WJA, Roelofs PDDM, Koes BW, Tulder MW, et al. Non‐steroidal anti‐inflammatory drugs for sciatica. Cochrane Database of Systematic Reviews 2016, Issue 10. [DOI: 10.1002/14651858.CD012382] - DOI - PMC - PubMed
Review Manager 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Saragiotto 2016
    1. Saragiotto BT, Machado GC, Ferreira ML. Pinheiro MB, Abdel Shaheed C, Maher CG. Paracetamol for low back pain. Cochrane Database of Systematic Reviews 2016, Issue 6. [DOI: 10.1002/14651858.CD012230] - DOI - PMC - PubMed
Schreijenberg 2019
    1. Schreijenberg M, Koes BW, Lin CWC. Guideline recommendations on the pharmacological management of non‐specific low back pain in primary care – is there a need to change?. Expert Review of Clinical Pharmacology 2019;12(2):145‐57. [DOI: 10.1080/17512433.2019.1565992] - DOI - PubMed
Sostres 2013
    1. Sostres C, Gargallo CJ, Lanas A. Nonsteroidal anti‐inflammatory drugs and upper and lower gastrointestinal mucosal damage. Arthritis Research & Therapy 2013 Jul 24 [Epub ahead of print];15(Suppl 3):S3. [DOI: 10.1186/ar4175; PUBMED: 24267289] - DOI - PMC - PubMed
Steenstra 2005
    1. Steenstra IA, Verbeek JH, Heymans WM, Bongers PM. Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature. Occupational and Environmental Medicine 2005;62:851‐60. [DOI: 10.1136/oem.2004.015842] - DOI - PMC - PubMed
Trelle 2011
    1. Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, et al. Cardiovascular safety of non‐steroidal anti‐inflammatory drugs: network meta‐analysis. BMJ 2011 Jan;342:c7086. [DOI: 10.1136/bmj.c7086; PUBMED: 21224324] - DOI - PMC - PubMed
van Tulder 2003
    1. Tulder M, Furlan A, Bombardier C, Bouter L. Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Spine 2003;28(12):1290‐9. - PubMed
Walker 2018
    1. Walker C, Biasucci LM. Cardiovascular safety of non‐steroidal anti‐inflammatory drugs revisited. Postgraduate Medicine 2018;130(1):55‐71. [DOI: ] - PubMed

References to other published versions of this review

Roelofs 2008
    1. Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, Tulder MW. Non‐steroidal anti‐inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. [DOI: 10.1002/14651858.CD000396.pub3] - DOI - PMC - PubMed
van Tulder 2000
    1. Tulder MW, Scholten RJ, Koes BW, Deyo RA. Non‐steroidal anti‐inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2000, Issue 2. [DOI: 10.1002/14651858.CD000396; CD000396; PUBMED: PMID: 10796356] - DOI - PubMed

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