AB1071 What factors affect the effectiveness of nsaids for acute low back pain?
Authors: A. Karateev, E. Pogozheva, A. Lila
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Nonsteroidal anti-inflammatory drugs (NSAID) are the main instruments for acute LBP (LOW BACK PAIN) treatment. However, up to now, factors that influence the effectiveness of NSAIDs have not been determined fully. <h3>Objectives</h3> To assess effects of some clinical and anamnestic factors on NSAIDs effectiveness in acute LBP. <h3>Methods</h3> The study group comprised 2078 patients (46.3±13.4 years, women 56.6%) with acute LBP treated in real clinical practice. 34.8% had first episode of LBP, 65.2% had second episode (an average of 2.6±1.4 episodes a year). Numerical rating scale (NRS) of 0–10 points estimated the level of pain. Initially, the pain level was 6.69±1.65, 57.0% of patients had severe pain (≥7 NRS). Pain remained at rest in 32.0%, at night in 19.0%, stiffness was noted in 60.7%, radiating leg pain in 28.2%, sciatica at 9.6%. NSAIDs used 70.2% of patients in the history of LBP, 28.0% rated their effectiveness as good, 54.6% as moderate and 17.4% as low. Meloxicam 15 mg once daily was prescribed for a period of up to 2 weeks for all the patients. 86.1% of patients received meloxicam intramuscular injection (i/m) for 2 days, then per os, 13.9% only per os. 52.3% received muscle relaxants, 17.4% – B vitamins, per os or i/m. 21.6% of patients received PPI for the prevention of gastrointestinal complications. The study evaluated the frequency of LBP complete relief with NSAIDs for up to 2 weeks. <h3>Results</h3> The complete pain relief was in 75.2% of patients, the average NSAID use duration before pain ceased was 8.6±5.5 days. 83.7% of patients rated the effect of treatment as "good" or "excellent." Adverse reactions were noted only in 4.6% of patients, there were no serious complications. Female sex and the use of B vitamins did not influence the outcome of the treatment: odds ratio (OR, 95% confidential interval) 0.967 (0.795–1.177), p=0.763 and 0.917 (0.804–1.1201), p=0.452. Age &lt;65 years, the first episode of LBP and a good effect of NSAIDs in a history were associated with the best result of treatment: OR 2.053 (1.592–2.642), p=0.000; 1.415 (1.09–1.836), p=0.009; 1.937 (1.513–2.481), p=0.000. Severe pain (≥7 NRS), pain at rest and at night, radiating leg pain and especially sciatica were associated with worse results: OR 0,599 (0,487–0,737), p=0,000; 0.481 (0.393–0.588), p=0.000; 0.559 (0.441–0.709), p=0.000; 0.511 (0.413–0.631), p=0.000; 0.346 (0.256–0.466), p=0.000. The combination of NSAIDs and muscle relaxants, in comparison with the monotherapy of NSAIDs, was associated with a lower incidence of pain: OR 0.827 (0.594–0.889), p=0.02. <h3>Conclusions</h3> Meloxicam 15 mg/day dosage is effective and safe for treating acute LBP. The sex of patients does not affect the outcome of treatment. Age &lt;65 years, first episode of LBP and a good "response" to NSAIDs in history are associated with better treatment outcomes. Severe pain, the pain at rest and pain at night, radiating leg pain and sciatica are associated with the worst result. The combination of NSAIDs with muscle relaxants and B vitamins did not improve the outcome of the treatment. <h3>Disclosure of Interest</h3> None declared