Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2016 Feb 10;2(2):CD012087.
doi: 10.1002/14651858.CD012087.

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

Wendy T M Enthoven  1 , Pepijn D D M Roelofs, Richard A Deyo, Maurits W van Tulder, Bart W Koes
Affiliations
Review

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

Wendy T M Enthoven et al. Cochrane Database Syst Rev. .

Abstract

Background: Chronic back pain is an important health problem. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat people with low back pain, especially people with acute back pain. Short term NSAID use is also recommended for pain relief in people with chronic back pain. Two types of NSAIDs are available and used to treat back pain: non-selective NSAIDs and selective COX-2 NSAIDs. In 2008, a Cochrane review identified a small but significant effect from NSAIDs compared to placebo in people with chronic back pain. This is an update of the Cochrane review published in 2008 and focuses on people with chronic low back pain.

Objectives: To determine if NSAIDs are more efficacious than various comparison treatments for non-specific chronic low back pain and if so, which type of NSAID is most efficacious.

Search methods: We searched CENTRAL, MEDLINE, EMBASE, PubMed and two clinical trials registry databases up to 24 June 2015 for randomized controlled trials (RCTs) published in English, German or Dutch. We also screened references cited in relevant reviews.

Selection criteria: We included RCTs (double-blind and single-blind) of NSAIDs used to treat people with chronic low back pain.

Data collection and analysis: Two review authors independently screened trials for inclusion in this Cochrane review according to the inclusion criteria. One review author extracted the data, and a second review author checked the data. Two review authors independently evaluated the risk of bias of all included trials. If data were clinically homogeneous, we performed a meta-analysis and assessed the quality of evidence using the GRADE approach.

Main results: We included 13 trials in this Cochrane review. Ten studies were at 'low' risk of bias. Six studies compared NSAIDs with placebo, and included 1354 participants in total. There is low quality evidence that NSAIDs are more effective than placebo, with a mean difference in pain intensity score from baseline of -3.30 (95% CI -5.33 to -1.27) on a 0 to 100 visual analogue scale (VAS) with a median follow-up of 56 days (interquartile range (IQR) 13 to 91 days). Four studies measured disability using the Roland Morris Disability Questionnaire. There is low quality evidence that NSAIDs are more effective than placebo on disability, with a mean difference from baseline of -0.85 (95% CI -1.30 to -0.40) on a scale from 0 to 24 with a median follow-up of 84 days (IQR 42 to 105 days). All six placebo controlled studies also reported adverse events, and suggested that adverse events are not statistically significant more frequent in participants using NSAIDs compared to placebo (RR 1.04, 95% CI 0.92 to 1.17). Due to the relatively small sample size and relatively short follow-up in most included trials, it is likely that the proportion of patients experiencing an adverse event is underestimated.Two studies compared different types of non-selective NSAIDs, namely ibuprofen versus diclofenac and piroxicam versus indomethacin. The trials did not find any differences between these NSAID types, but both trials had small sample sizes. One trial reported no differences in pain intensity between treatment groups that used selective or non-selective NSAIDs. One other trial compared diflunisal with paracetamol and showed no difference in improvement from baseline on pain intensity score. One trial showed a better global improvement in favour of celecoxib versus tramadol.One included trial compared NSAIDs with 'home-based exercise'. Disability improved more in participants who did exercises versus participants receiving NSAIDs, but pain scores were similar.

Authors' conclusions: Six of the 13 included RCTs showed that NSAIDs are more effective than placebo regarding pain intensity. NSAIDs are slightly more effective than placebo regarding disability. However, the magnitude of the effects is small, and the level of evidence was low. When we only included RCTs at low risk of bias, differences in effect between NSAIDs and placebo were reduced. We identified no difference in efficacy between different NSAID types, including selective versus non-selective NSAIDs. Due to inclusion of RCTs only, the relatively small sample sizes and relatively short follow-up in most included trials, we cannot make firm statements about the occurrence of adverse events or whether NSAIDs are safe for long-term use.

PubMed Disclaimer

Conflict of interest statement

Wendy TM Enthoven has no known conflicts of interest.

Pepijn DDM Roelofs has no known conflicts of interest.

Richard A Deyo has no known conflicts of interest.

Maurits W van Tulder has no known conflicts of interest.

Bart W Koes has no known conflicts of interest.

Figures

1
1
study flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included trial.
3
3
'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included trials.
4
4
Funnel plot of comparison: 1 NSAIDs versus placebo, outcome: 1.1 Change in pain intensity from baseline on 100 mm VAS. Follow‐up ≤ 12 weeks.
5
5
Funnel plot of comparison: 1 NSAIDs versus placebo, outcome: 1.2 Change in disability from baseline.
6
6
Funnel plot of comparison: 1 NSAIDs versus placebo, outcome: 1.3 Proportion of patients experiencing adverse events. Follow‐up ≤ 16 weeks.
1.1
1.1. Analysis
Comparison 1 NSAIDs versus placebo, Outcome 1 Change in pain intensity from baseline on 100 mm VAS. Follow‐up ≤ 16 weeks..
1.2
1.2. Analysis
Comparison 1 NSAIDs versus placebo, Outcome 2 Change in disability from baseline.
1.3
1.3. Analysis
Comparison 1 NSAIDs versus placebo, Outcome 3 Proportion of patients experiencing adverse events. Follow‐up ≤ 16 weeks..
1.4
1.4. Analysis
Comparison 1 NSAIDs versus placebo, Outcome 4 Sensitivity analysis: change in pain intensity from baseline on 100 mm VAS. Follow‐up ≤ 16 weeks..
1.5
1.5. Analysis
Comparison 1 NSAIDs versus placebo, Outcome 5 Sensitivity analysis: change in disability from baseline.
1.6
1.6. Analysis
Comparison 1 NSAIDs versus placebo, Outcome 6 Sensitivity analysis: proportion of patients experiencing adverse events. Follow‐up ≤ 16 weeks..
2.1
2.1. Analysis
Comparison 2 NSAIDs versus other drug treatment, Outcome 1 Proportion of patients experiencing global improvement. Follow‐up ≤ 6 weeks..
2.2
2.2. Analysis
Comparison 2 NSAIDs versus other drug treatment, Outcome 2 Proportion of patients experiencing adverse events. Follow‐up ≤ 6 weeks..
See this image and copyright information in PMC

Comment in

  • NSAIDs for Chronic Low Back Pain.
    Enthoven WTM, Roelofs PD, Koes BW. Enthoven WTM, et al. JAMA. 2017 Jun 13;317(22):2327-2328. doi: 10.1001/jama.2017.4571. JAMA. 2017. PMID: 28609520 Review.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in 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
Berry 1982 {published data only}
    1. Berry H, Bloom B, Hamilton EBD, Swinson DR. Naproxen sodium, diflunisal, and placebo in the treatment of chronic back pain. Annals of the Rheumatic Diseases 1982;41(2):129‐32. - PMC - PubMed
Birbara 2003 {published data only}
    1. Birbara CA, Puopolo AD, Munoz DR, Sheldon EA, Mangione A, Bohidar NR, et al. Treatment of chronic low back pain with etoricoxib, a new cyclo‐oxygenase‐2 selective inhibitor: improvement in pain and disability‐‐a randomized, placebo‐controlled, 3‐month trial. The Journal of Pain 2003;4(6):307‐15. - 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
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 1994;55(11):1283‐92.
Hickey 1982 {published data only}
    1. Hickey RF. Chronic low back pain: a comparison of diflunisal with paracetamol. The New Zealand Medical Journal 1982;95(707):312‐4. - PubMed
Katz 2011 {published data only}
    1. Katz N, Borenstein DG, Birbara C, Bramson C, Nemeth MA, Smith MD, et al. Efficacy and safety of tanezumab in the treatment of chronic low back pain. Pain 2011;152(10):2248‐58. - PubMed
Kivitz 2013 {published data only}
    1. Kivitz AJ, Gimbel JS, Bramson C, Nemeth MA, Keller DS, Brown MT, et al. Efficacy and safety of tanezumab versus naproxen in the treatment of chronic low back pain. Pain 2013;154(7):1009‐21. - PubMed
O'Donnell 2009 {published data only}
    1. O'Donnell JB, Ekman EF, Spalding WM, Bhadra P, McCabe D, Berger MF. The effectiveness of a weak opioid medication versus a cyclo‐oxygenase‐2 (COX‐2) selective non‐steroidal anti‐inflammatory drug in treating flare‐up of chronic low‐back pain: results from two randomized, double‐blind, 6‐week studies. Journal of International Medical Research 2009;37(6):1789‐802. - PubMed
Romanò 2009 {published data only}
    1. Romanò CL, Romanò D, Bonora C, Mineo G. Pregabalin, celecoxib, and their combination for treatment of chronic low‐back pain. Journal of Orthopaedics and Traumatology 2009;10(4):185‐91. - PMC - PubMed
Shirado 2010 {published data only}
    1. Shirado O, Doi T, Akai M, Hoshino Y, Fujino K, Hayashi K, et al. Multicenter randomized controlled trial to evaluate the effect of home‐based exercise on patients with chronic low back pain: the Japan low back pain exercise therapy study. Spine 2010;35(17):E811‐9. - PubMed
Videman 1984 {published data only}
    1. Videman T, Osterman K. Double‐blind parallel study of piroxicam versus indomethacin in the treatment of low back pain. Annals of Clinical Research 1984;16(3):156‐60. - PubMed
Zerbini 2005 {published data only}
    1. Zerbini C, Ozturk ZE, Grifka J, Maini M, Nilganuwong S, Morales R, et al. Efficacy of etoricoxib 60 mg/day and diclofenac 150 mg/day in reduction of pain and disability in patients with chronic low back pain: results of a 4‐week, multinational, randomized, double‐blind study. Current Medical Research and Opinion 2005;21(12):2037‐49. - PubMed

References to studies excluded from this review

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(3):247‐52. - PubMed
Babey‐Dölle 1994 {published data only}
    1. Babej‐Dölle 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(4):204‐9. - PubMed
Borghi 2013 {published data only}
    1. Borghi B, Aurini L, White PF, Mordenti A, Lolli F, Borghi R, et al. Long‐lasting beneficial effects of periradicular injection of meloxicam for treating chronic low back pain and sciatica. Minerva Anestesiologica 2013;79(4):370‐8. - PubMed
Chang 2013 {published data only}
    1. Chang WK, Wu HL, Yang CS, Chang KY, Liu CL, Chan KH, et al. Effect on pain relief and inflammatory response following addition of tenoxicam to intravenous patient‐controlled morphine analgesia: a double‐blind, randomized, controlled study in patients undergoing spine fusion surgery. Pain Medicine 2013;14(5):736‐48. - 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 2003;42(1):141‐8. - 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, Géczy J, Vandekerckhove K, Appelboom T. Open controlled randomized multicenter comparison of nimesulide and diclofenacin the treatment of subacute and chronic low back pain. Journal of Drug Assessment 1998;1:349‐68.
Ingpen 1969 {published data only}
    1. Ingpen ML. A controlled clinical trial of sustained‐action dextropropoxyphene hydrochloride. British Journal of Clinical Practice 1969;23(3):113‐5. - 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(5611):158‐60. - PMC - PubMed
Jaffé 1974 {published data only}
    1. Jaffé 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(7):424‐9. - PubMed
Katz 2003 {published data only}
    1. Katz N, Ju WD, Krupa DA, Sperling RS, Bozalis Rodgers D, Gertz BJ, et al. Efficacy and safety of rofecoxib in patients with chronic low back pain: results from two 4‐week, randomized, placebo‐controlled, parallel‐group, double‐blind trials. Spine 2003;28(9):851‐8. - PubMed
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;2:51‐2.
Matsumo 1991 {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 1991;35(7‐8):266. - PubMed
Merkulova 2013 {published data only}
    1. Merkulova DM, Onsin AA, Merkulov YA. Piascledin in the treatment of chronic dorsalgia. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova 2013;113(9):18‐22. - PubMed
Peng 2014 {published data only}
    1. Peng YL, Wu QM, Li YF, Mu CY, Hu AH, Zhang Y. Temperature‐controlled self‐heated pain relief plaster for chronic nonspecific lower back pain: A prospective randomized controlled trial. Chinese Journal of Evidence‐Based Medicine 2014;2:147‐51.
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‐Orthopaedics 1988;6:28‐35.
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(5):369‐74. - PubMed
Tavafian 2014 {published data only}
    1. Tavafian SS, Jamshidi AR, Mohammad K. Treatment of low back pain: randomized clinical trial comparing a multidisciplinary group‐based rehabilitation program with oral drug treatment up to 12 months. International Journal of Rheumatic Diseases 2014;17(2):159‐64. - PubMed
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(1):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(8):486‐90. - PubMed
Wetzel 2014 {published data only}
    1. Wetzel L, Zadrazil M, Paternostro‐Sluga T, Authried G, Kozek‐Langenecker S, Scharbert G. Intravenous nonopioid analgesic drugs in chronic low back pain patients on chronic opioid treatment: a crossover, randomised, double‐blinded, placebo‐controlled study. European Journal of Anaesthesiology 2014;31(1):35‐40. - PubMed

Additional references

Airaksinen 2006
    1. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber‐Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. European Spine Journal 2006;15(Suppl 2):S192‐300. [PUBMED: 16550448] - PMC - PubMed
Boutron 2005
    1. Boutron I, Estellat C, Ravaud P. A review of blinding in randomized controlled trials found results inconsistent and questionable.. Journal of Clinical Epidemiology 2005;58:1220‐6. - PubMed
Cassidy 1998
    1. Cassidy JD, Carroll LJ, Côté P. The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976) 1998 Sep 1;23(17):1860‐6. [PUBMED: 9762743] - PubMed
Castellsague 2012
    1. Castellsague J, Riera‐Guardia N, Calingaert B, Varas‐Lorenzo C, Fourrier‐Reglat A, Nicotra F, et al. Individual NSAIDs and upper gastrointestinal complications: a systematic review and meta‐analysis of observational studies (the SOS project). Drug Safety 2012;35(12):1127‐46. [PUBMED: 23137151] - PMC - PubMed
Chung 2013
    1. Chung JW, Zeng Y, Wong TK. Drug therapy for the treatment of chronic nonspecific low back pain: systematic review and meta‐analysis. Pain Physician 2013;16(6):E685‐704. [PUBMED: 24284847] - PubMed
CNT Collaboration 2013
    1. Coxib and traditional NSAID Trialists' (CNT) Collaboration, Bhala N, Emberson J, Merhi A, Abramson S, Arber N, et al. Vascular and upper gastrointestinal effects of non‐steroidal anti‐inflammatory drugs: meta‐analyses of individual participant data from randomised trials. Lancet 2013;382(9894):769‐79. [PUBMED: 23726390] - PMC - PubMed
Deyo 2006
    1. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine (Phila Pa 1976) 2006;31(23):2724‐7. [PUBMED: 17077742] - PubMed
Duffy 2014
    1. Duffy S, Misso K, Noake C, Ross J, Stirk L. Supplementary searches of PubMed to improve currency of MEDLINE and MEDLINE In‐Process searches via OvidSP. Kleijnen Systematic Reviews Ltd, York. Poster presented at the UK InterTASC Information Specialists' Sub‐Group (ISSG) Workshop; 9 July 2014; Exeter, UK. https://medicine.exeter.ac.uk/media/universityofexeter/medicalschool/res... (accessed 06/08/2014). - PubMed
Furlan 2009
    1. Furlan AD, Pennick V, Bombardier C, Tulder M, Editorial Board, Cochrane Back Review Group. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine 2009;34(18):1929‐41. - PubMed
Galandi 2006
    1. Galandi D, Schwarzer G, Antes G. The demise of the randomised controlled trial: bibliometric study of the German‐language health care literature, 1948 to 2004. BMC Med Res Methodol 2006;6:6‐30. [MEDLINE: ] - PMC - PubMed
Gore 2012
    1. Gore M, Tai KS, Sadosky A, Leslie D, Stacey BR. Use and costs of prescription medications and alternative treatments in patients with osteoarthritis and chronic low back pain in community‐based settings. Pain Practice 2012;12(7):550‐60. [PUBMED: 22304678] - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
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 2013;17(1):5‐15. [PUBMED: 22641374] - PubMed
Jüni 2002
    1. Jüni P, Holenstein F, Sterne J, Bartlett C, Egger M. Direction and impact of language bias in meta‐analyses of controlled trials: empirical study.. Int J Epidemiol. 2002;31(1):115‐23. [MEDLINE: ] - PubMed
Kearney 2006
    1. Kearney P, Baigent C, Godwin J, Halls H, Emberson J, Patrono C. Do selective cyclo‐oxygenase‐2 inhibitors and traditional non‐steroidal anti‐inflammatory drugs increase the risk of atherothrombosis? Meta‐analysis of randomised trials. BMJ 2006;332(7553):1302‐8. [PUBMED: 16740558] - PMC - PubMed
Koes 2010
    1. Koes BW, Tulder M, 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;19(12):2075‐94. - PMC - PubMed
Kuijpers 2011
    1. Kuijpers T, Middelkoop M, Rubinstein SM, Ostelo R, Verhagen A, Koes BW, et al. A systematic review on the effectiveness of pharmacological interventions for chronic non‐specific low‐back pain. European Spine Journal 2011;20(1):40‐50. [PUBMED: 20680369] - PMC - PubMed
Lexchin 2003
    1. Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 2003;326(7400):1167‐70. [PUBMED: 12775614] - PMC - PubMed
Moher 2003
    1. Moher D, Pham B, Lawson ML, Klassen TP. The inclusion of reports of randomised trials published in languages other than English in systematic reviews. Health Technol Assess 2003;7(41):1‐90. [MEDLINE: ] - PubMed
Müller‐Schwefe 2011a
    1. Müller‐Schwefe GH. European survey of chronic pain patients: results for Germany. Current Medical Research and Opinion 2011;27(11):2099‐106. [PUBMED: 21933101] - PubMed
Müller‐Schwefe 2011b
    1. Müller‐Schwefe G, Freytag A, Höer A, Schiffhorst G, Becker A, Casser HR, et al. Healthcare utilization of back pain patients: results of a claims data analysis. Journal of Medical Economics 2011;14(6):816‐23. [PUBMED: 21992218] - PubMed
Pallay 2004
    1. Pallay RM, Seger W, Adler JL, Ettlinger RE, Quaidoo EA, Lipetz R, et al. Etoricoxib reduced pain and disability and improved quality of life in patients with chronic low back pain: a 3 month, randomized, controlled trial. Scandinavian Journal of Rheumatology 2004;33(4):257‐66. [PUBMED: 15370723] - PubMed
Piccoliori 2013
    1. Piccoliori G, Engl A, Gatterer D, Sessa E, in der Schmitten J, Abholz HH. Management of low back pain in general practice ‐ is it of acceptable quality: an observational study among 25 general practices in South Tyrol (Italy). BMC Family Practice 2013;14:148. [PUBMED: 24090155] - PMC - 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;15(Suppl 3):S3. [PUBMED: 24267289] - 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;342:c7086. [PUBMED: 21224324] - PMC - PubMed
van Tulder 2003
    1. Tulder M, Furlan A, Bombardier C, Bouter L, Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine 2003;28(12):1290‐9. - PubMed
Vos 2012
    1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990‐2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380(9859):2163‐96. [PUBMED: 23245607] - PMC - PubMed
Walker 2000
    1. Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. Journal of Spinal Disorders 2000;13(3):205‐17. - PubMed
Webb 2003
    1. Webb R, Brammah T, Lunt M, Urwin M, Allison T, Symmons D. Prevalence and predictors of intense, chronic, and disabling neck and back pain in the UK general population. Spine (Phila Pa 1976) 2003;28(11):1195‐202. [PUBMED: 12782992] - PubMed
Wehling 2014
    1. Wehling M. Non‐steroidal anti‐inflammatory drug use in chronic pain conditions with special emphasis on the elderly and patients with relevant comorbidities: management and mitigation of risks and adverse effects. European Journal of Clinical Pharmacology 2014;70(10):1159‐72. [PUBMED: 25163793] - 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

MeSH terms