Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line medications for chronic low back pain. Tramadol, opioids, and other complementary medications may be beneficial for some patients who don't respond to NSAIDs. Your doctor may suggest it as a first-line treatment, as it works by stopping the pain process. However, it doesn't reduce inflammation in the body.
Clinical guidelines and evidence-based research support the fact that exercise and intensive, multidisciplinary pain management programs are effective for chronic low back pain. A recent randomized clinical trial revealed that patients with acute or subacute low back pain had significantly better functional outcomes when receiving complementary therapy compared to unmatched treatment. The evidence-based recommendations urge physicians and patients to omit drug treatment as a first-line treatment for non-radicular low back pain. More than 1000 randomized controlled trials have been published evaluating all types of conservative, complementary or surgical treatments for low back pain commonly used in primary and secondary care.
These interventions were found to be as effective as a variety of placebos, simulated or without treatment. In addition, currently available clinical guidelines do not provide clear recommendations on the optimal treatment of patients at risk (due to their psychosocial profile) once they have been identified. Previous studies also found better results with compatible treatments in subgroups of patients with non-specific low back pain. Depending on each patient's unique situation and condition, conservative treatments and over-the-counter pain medications may not address the underlying problem.
The guidelines emphasize that doctors should only consider opioids as a last-line treatment option in patients who have shown an inadequate response to other treatments. Up-to-date evidence is available for doctors on the benefits and harms of treatments for a variety of disorders, including low back pain.
