PAIN-BACK PAIN, PHARMACOLOGICAL MGM
SUMMARY
1. Medications may be used to enable activity.
2. Paracetamol: recommendation as 1st line therapy is now being questioned.
3. NSAIDs: 2nd line therapy, use low doses, ≤ 2 weeks.
4. Opioids: limited role. 3 days is often sufficient, possibly combine with paracetamol.
5. Avoid muscle relaxants, benzodiazepines, anticonvulsants.
6. Combining paracetamol with NSAID or opioid may reduce dose requirements.
7. Do note that a meta-analysis of 13 RCTs showed that there was no benefit for paracetamol in LBP. Hip and knee OA: small effect on pain (< 4/100), probably not clinically meaningful[1].
Reference(s)
- ↑ Machado G C, Maher C G, Ferreira P H, Pinheiro M B, Lin C C, Day R O et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials BMJ 2015; 350 :h1225 doi:10.1136/bmj.h1225
Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.
