Abstract
In pharmacotherapy of acute non-specific back pain we proceed with respect to the intensity of pain and contraindications of non-steroid anti-inflammatory drugs (NSAIDs). A procedure from "above to down" is used (selecting initially a stronger and a faster acting analgesic).
In medium and stronger back pain (VAS 4-7), a NSAID is prescribed if not contraindicated (e.g. ibuprofen 400 mg or diclofenac 50 mg), or paracetamol in a sufficient dose (1000 mg) possibly in combination with tramadol or codeine. According to the European guidelines paracetamol is to be preferred as first choice medication for acute low back pain, while NSAIDs are recommended as a second choice.
A combination of paracetamol and mild opioids may be used. The choice of pharmacotherapy is individual depending on efficacy and tolerability in a specific patient.
There is evidence that central muscle relaxants have analgesic effect in back pain, but they should be given shortly (a few days at most) and in accord with their kinetics. In very severe acute back pains, strong opioids or infusions of analgesics with muscle relaxants are used.
In management of chronic non-specific back pain, pharmacotherapy is less dominant. Cognitive behavioural therapy, exercise therapy and other non-pharmacological treatments are usually more important.
Although there is evidence for efficacy of NSAIDs and opioids in non-specific chronic back pain, only a short-term administration of NSAIDs (e.g. during exacerbation) is advised in chronic back pain because of risks of this therapy. A certain improvement was found after some antidepressants (cyclic, SNRI e.g. duloxetin, venlafaxin, but not SSRI) and after benzodiazepines