• M M Wertli and J Steurer.
• Universitätsklinik für Allgemeine Innere Medizin, Inselspital Bern, Freiburgstr. 16p, 3010, Bern, Schweiz. maria.wertli@insel.ch.
• Internist (Berl). 2018 Nov 1; 59 (11): 1214-1223.

AbstractLow back pain is common. In the acute (duration <6 weeks) and subacute pain phases (6-12 weeks) the main goal of pharmacological pain treatment is to enable patients to move and to stay as active as possible. In the chronic phase, pain medications can support non-pharmacological measures and improve physical function. Although almost every person will experience low back pain at least once in a lifetime, for many pain medications no clinical studies on their efficacy exist. Most data are available on the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) in acute and chronic low back pain; however, potential adverse effects and contraindications for NSAIDs need to be taken into account when the medication is prescribed. For other non-opioid medications (e. g. paracetamol, metamizole) the efficacy is not well studied. Weak and strong opioids have been shown to be effective compared to placebo in the short term; however, there is increasing evidence that opioids are no more effective than non-opioid medications in the treatment of acute and chronic low back pain. Furthermore, gastrointestinal and central nervous system adverse effects of opioids should be considered. Conclusion: in low back pain, the choice of a specific pain medications is based on the individual patient preferences, contraindications, and potential adverse effects. The main goal of pain medications is to enable patients to stay active. In persisting pain, non-pharmacological measures are important and should complement pharmacological pain treatment.

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