Pharmacotherapy in lower back pain

In the US, back pain is the second most common cause of disability and the leading cause among men, with approximately 45% of the adult population experiencing lower back pain annually and a direct cost for diagnosis and treatment reported to be higher than 23 billion US dollars in 1990. However, despite the high prevalence of this condition, lower back pain diagnoses are commonly imprecise, and specific causes for lower back pain can only be determined in approximately 15% of patients. So, although for most patients with acute lower back pain, a simple cause-and-effect model can be described, often the result of a lumbar sprain or strain, clinicians must be alert to a variety of other conditions which may present in a similar fashion and require more emergent care. Pharmacotherapy and nondrug-related modalities have been shown to reduce pain and other related symptoms. Medication classes with known benefit include the nonsteroidal antiinflammatory drugs (NSAIDs), skeletal muscle relaxants, opioids, acetaminophen and the newer cyclooxygenase-2 (COX-2) inhibitors. This review analyzes the different drugs available for treating lower back pain in light of the most recent evidence coming from clinical studies. More critical research is needed to further define the roles of these medications in treating pain associated with lower back injury.