Reacción a "Reaction: meta-analysis finds lack of scientific evidence on efficacy and safety of painkillers for low back pain"

This is a very interesting study that conducted a systematic review and meta-analysis of a total of 98 randomised controlled studies of pharmacological treatments in patients with acute low back pain. It is particularly interesting because of its design that aggregates data from more than 15,000 participants, 49% of whom were women. It concludes that the effectiveness and safety of approved treatments for the management of acute low back pain are questionable, and that studies of higher quality are needed to improve the drug treatment regimens used to treat this frequent, painful condition.  

 This conclusion is of great importance for clinical practice and reaffirms previous studies that have already shown a lack of evidence on the ability of some analgesic drugs to reduce the intensity of acute low back pain. This uncertainty really makes it complicated for primary care clinicians when it comes to making decisions on the prescription of anti-inflammatory drugs, anticonvulsants, opioids, combinations of both, paracetamol or corticoids to treat this condition. Therefore, without such evidence to support their use, prescribing [such drugs] should be limited. However, it is important to note some of the limitations of the study that the authors mention themselves, such as the selection of patients or the lack or high variety of the type of adverse effects data collected in the different studies considered for this meta-analysis. It is for this reason that the authors reaffirm the need to continue these studies, in order to improve our knowledge of the use of analgesic therapies for the treatment of pain.  

Taking into account these results, which could be extended to the Spanish population, it is necessary to promote research in this field, as the same study calls for caution when interpreting these results of efficacy and side effects.  

Although of great importance, the conclusions obtained will not yet have an impact on patients' treatment regimens. But they should focus our attention on the outcomes of analgesic use by both patients and their physicians, to avoid side effects and to implement the necessary measures, including switching, discontinuation of analgesic use or use of other non-pharmacological measures, to improve the clinical management of the patient.