BMJ released: A meta-analysis of 49 clinical trials, non-benzodiazepine antispasmodics have no clear efficacy and increase the risk of adverse events

Low back pain is a common clinical symptom that destroys hundreds of thousands of patients worldwide
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In the United States, low back pain is the highest proportion of health care expenditures
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Muscle relaxants are the third most commonly used drugs for the treatment of low back pain.
Doctors often prescribe muscle relaxants to control the symptoms of patients
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However, the use of muscle relaxants conflicts with international clinical practice guidelines for low back pain
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For example, the US guidelines recommend non-benzodiazepine anticonvulsants as the first choice for acute low back pain, while the Belgian guidelines discourage their use, and the British guidelines do not give recommendations
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So, should muscle relaxants be used? Does its application have any clinical effects? Recently, the "British Medical Journal" published an online study titled "Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis" by the James H McAuley team of the Australian Institute of Neuroscience.

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The study systematically evaluated the efficacy, compliance and safety of muscle relaxants in the treatment of non-specific low back pain in adults
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DOI: 10.
1136/bmj.
n1446 Researchers searched several commonly used databases and clinical research registration platforms, and extracted 3362 records
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After screening, the researchers analyzed 49 studies, including 6505 participants and 18 different drugs.
They were non-benzodiazepine anticonvulsants (n=29) and other drugs (n=11).
), anticonvulsants (n=5) and benzodiazepines (n=4)
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Researchers use the Cochrane risk of bias tool and recommendation classification, evaluation, development, and evaluation to independently identify the research, extract data, and evaluate the risk of bias and certainty of the evidence
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The random effects meta-analysis model is used to evaluate the pooled effects and the corresponding 95% confidence interval by limiting the maximum likelihood estimation
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Through the pain intensity (measured on a 0-100 subscale), disability (0-100 subscale), compliance (withdrawal for any reason during treatment), and safety (adverse events, serious adverse events, and withdrawal from the trial due to adverse events) The number of participants) comprehensive evaluation of its efficacy in several aspects
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The results of analysis of the efficacy of muscle relaxants in various studies show that for patients with acute low back pain, non-benzodiazepine drugs can reduce the pain intensity, but this reduction effect is slight and has no significant clinical significance; In patients with acute and chronic low back pain, there is no reliable evidence that non-benzodiazepines have a positive effect
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Summary of the related effects of various muscle relaxants.
In a number of studies included in the analysis by the researchers, reports on the adverse time of muscle relaxants in the treatment of acute low back pain are different.
The analysis results show that: in the treatment of acute low back pain, non-benzene two Zapine anticonvulsants are associated with an increased risk of adverse events; for chronic and mixed low back pain, the risk of adverse events from non-benzodiazepine anticonvulsants is not different from that of the control group
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Summary of evidence on the safety of muscle relaxants in the treatment of low back pain.
In summary, although the non-benzodiazepine anticonvulsants in this study have a pain relief effect in the treatment of acute low back pain, the therapeutic effect is too small and the researchers believe that it is not Has clinical significance
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At the same time, the certainty of the research evidence is low, and there is no conclusive evidence to support the efficacy and safety of non-benzodiazepine anticonvulsants
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Instead, there is evidence that the use of non-benzodiazepine anticonvulsants may increase the risk of adverse events
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The researchers call on clinicians to actively discuss the uncertainty of the effectiveness and safety of muscle relaxants with patients, and to remind the possibility of increased risk of adverse events so that patients can make treatment choices with informed consent
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