This systematic review informs the content of the latest clinical practice guideline for non-invasive treatments for lower back pain, from the American College of Physicians.
Separately, NICE has also issued a clinical guideline which covers assessing and managing low back pain and sciatica in people aged 16 and over. It outlines physical, psychological, pharmacological and surgical treatments to help people manage low back pain and sciatica.
NICE recommends that oral NSAIDs be considered for managing low back pain, taking into account potential differences in gastrointestinal, liver and cardio-renal toxicity, and the person's risk factors, including age. A weak opioid (with or without paracetamol) may be considered for managing acute low back pain only if an NSAID is contraindicated, not tolerated or has been ineffective. Paracetamol alone is not recommended for low back pain. (Please see link for full recommendations)
In a related editorial describing the systematic reviews and the ACP guideline, the author notes that the ACP guideline recommends an initial focus on non-pharmacologic therapies rather than medications, and though reasonable, this strategy may represent a major change for primary care clinicians whilst little direct evidence exists to support it.