Medicines for Back Pain


Medicines are the most common treatment for back pain. The aim of this program of research is to improve our understanding of the clinical effects of medicines.

Studies currently in progress: 
  1. Scoping review of paracetamol, NSAIDs and opioid analgesics for chronic low back pain (led by Matthew K Bagg). The objective of this study is to identify and describe the characteristics of available clinical trials of commonly used analgesic medicines for chronic low back pain. This information will inform the design and conduct of other studies in the research program.
  2. Paracetamol, NSAIDs and opioid analgesics for chronic low back pain: a network meta-analysis (led by Matthew K Bagg). The objective of this study is to produce information about the clinical effects of available analgesic medicines for chronic low back pain. This information will be available in a Cochrane review to assist clinical prescription of medicines. The protocol is published and available here.
  3. Prescribing practices of medicines for adults with low back pain: a systematic review (led by Michael Wewege). The objective of this study is to determine how different medicines are prescribed to adults with low back pain and how this differs across countries. The protocol for this study is being developed.
  4. Analgesic medicines for adults with low back pain: a network meta-analysis (led by Michael Wewege). The objective of this study is to evaluate the comparative effectiveness of a range of analgesic medicines for adults across different classifications of low back pain. The protocol for this study has been submitted for publication.
  5. Muscle relaxant medicines for low back pain: a systematic review and meta-analysis (led by Aidan Cashin and Thiago Folly). The objective of this study is to determine the effectiveness and tolerability of muscle relaxant medicines for adults with low back pain. The protocol is available here.
  6. Novel biologic medicines for low back pain: a systematic review and meta-analysis (led by Rodrigo Rizzo). The objective of this study is to determine the effectiveness and tolerability of novel biologic medicines for adults with low back pain. The protocol is available here.
Completed studies 
  1. Evaluation of the impact of unpublished data from clinical trial registries on the effects of medicines for low back pain (led by Matthew Bagg). The objective of this study was to evaluate whether there is a difference between clinical trial data that are published and those that are not published. The findings are published in the Journal of Clinical Epidemiology.
  2. Antidepressant medicines for low back pain: a systematic review and meta-analysis (led by Michael Ferraro). The objective of this study was to determine the effectiveness and tolerability of antidepressant medicines for adults with low back pain. The findings have been submitted for publication. The protocol is available here.
Publications 
  • Wewege, M. A., Bagg, M. K., Jones, M. D., Ferraro, M. C., Cashin, A. G., Rizzo, R. R., Leake, H. B., Hagstrom, A. D., Sharma, S., McLachlan, A. J., Maher, C. G., Day, R., Wand, B. M., O’Connell, N. E., Nikolakopolou, A., Schabrun, S., Gustin, S. M., & McAuley, J. H. (2023). Comparative effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain: systematic review and network meta-analysis. BMJ, 380, e072962. doi:10.1136/bmj-2022 – 072962
  • Wewege, M. A., Jones, M. D., Williams, S. A., Kamper, S. J., & McAuley, J. H. (2022). Rescaling pain intensity measures for meta-analyses of analgesic medicines for low back pain appears justified: an empirical examination from randomised trials. BMC Med Res Methodol, 22(1), 285. doi:10.1186/s12874-022 – 01763‑x
  • Cashin, A. G., Folly, T., Bagg, M. K., Wewege, M. A., Jones, M. D., Ferraro, M. C., Leake, H. B., Rizzo, R. R. N., Schabrun, S. M., Gustin, S. M., Day, R., Williams, C. M., & McAuley, J. H. (2021). Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ, 374, n1446. doi:10.1136/bmj.n1446
  • Rizzo, R. R. N., Ferraro, M. C., Wewege, M. A., Cashin, A. G., Leake, H. B., O’Hagan, E. T., Jones, M. D., Gustin, S. M., & McAuley, J. H. (2021). Efficacy and Safety of Medicines Targeting Neurotrophic Factors in the Management of Low Back Pain: Protocol for a Systematic Review and Meta-analysis. JMIR Res Protoc, 10(1), e22905. doi:10.2196/22905
  • Rizzo, R. R. N., Ferraro, M. C., Wewege, M. A., Cashin, A. G., Leake, H. B., O’Hagan, E. T., Jones, M. D., Gustin, S. M., McLachlan, A. J., Day, R., & McAuley, J. H. (2021). Targeting Neurotrophic Factors for Low Back Pain and Sciatica: A Systematic Review and Meta-analysis. Rheumatology (Oxford). doi:10.1093/rheumatology/keab785
  • Ferraro, M. C., Bagg, M. K., Wewege, M. A., Cashin, A. G., Leake, H. B., Rizzo, R. R. N., Jones, M. D., Gustin, S. M., Day, R., Loo, C. K., & McAuley, J. H. (2021). Efficacy, acceptability, and safety of antidepressants for low back pain: a systematic review and meta-analysis. Syst Rev, 10(1), 62. doi:10.1186/s13643-021 – 015994
  • Bagg MK, McLachlan AJ, Maher CG, Kamper SJ, Williams CM, Henschke N, Wand BM, Moseley GL, Hübscher M, O’Connell NE, van Tulder MW, Nikolakopoulou A, McAuley JH. (2018). Paracetamol, NSAIDS and opioid analgesics for chronic low back pain: a network meta-analysis [Protocol]. Cochrane Database of Systematic Reviews, Issue 6. doi: 10.1002/14651858.CD013045. PMCID: PMC6513465
  • Bagg MK, O’Hagan E, Zahara P, Wand BM, Hübscher M, Moseley GL, McAuley JH. (2020). Reviews may overestimate the effectiveness of medicines for back pain: systematic review and meta-analysis. Journal of Clinical Epidemiology. doi: 10.1016/ j.jclinepi.2019.12.006. PMID: 31816418
Registrations of Study Protocols 
  • Folly T, Bagg MK, Wewege M, Ferraro MC, Schabrun S, Gustin SM, Day R, McAuley JH. (2019) UMbRELLA: Understanding efficacy and safety of Muscle RELaxant medicines for Low back pain – systematic Literature review and meta-Analysis (protocol).Open Science Framework, available at: https://​osf​.io/​xuw5h
  • Rizzo RN, Bagg MK, Ferraro MC, Wewege M, Cashin A, Leake HB, O’Hagan E, Jones M, McAuley JH. (2020). Efficacy and safety of medicines targeting neurotrophic factors in the management of low back pain: protocol for a systematic review and meta-analysis. Open Science Framework, available at: https://​osf​.io/​zax6d
  • Ferraro MC, Bagg MK, McAuley JH. (2019). RADICAL: Systematic Review of Anti-Depressant Medicines if Considered Analgesics for Low Back Pain (protocol). Open Science Framework, available at: https://​osf​.io/​cedm3