Current and Future Pharmacological Agents for the Treatment of Back Pain — Expert Opinion on Pharmacotherapy

Bhatia A, Engle A, Cohen SP

Choosing appropriate pharmacotherapy for acute and chronic LBP continues to pose a major challenge to health-care providers and sufferers. Identifying distinct phenotypes that respond to targeted treatments, improving diagnosis to enable mechanism-based rather than symptom-based treatment of pain (e.g. muscle relaxants for muscle spasms, antidepressants for LBP with a neuropathic character), treating concomitant conditions that may undermine effectiveness (e.g. sleep and psychological disorders) and exploring stepped care and interdisciplinary models, while monitoring for adverse effects are promising approaches that need to be studied for comparative-effectiveness against standard of care. The paucity of pharmacologic treatments for LBP has spurred a search for more efficacious and safer medications. Although they have not been extensively studied for back pain per se, intravenous infusion tests designed to identify pain mechanisms and predict response to oral analgesic therapy represents an area ripe for investigation [30]. Nerve growth factor inhibitors, cannabinoids, newer opioids, ketamine, and botulinum toxin have been evaluated in a variety of clinical studies for LBP. The evidence regarding the role of these therapies is mixed and of low quality. Table 2 provides a summary of some of the important studies on these agents in the last decade. Increasing evidence on newer options will help to optimize the treatment of this challenging and growing problem. It is also important to consider non-pharmacological options for LBP such as physical therapy and psychological treatments. Health-care providers should advise their patients with low back pain about non-pharmacological analgesic options that are supported by evidence of efficacy and safety, while informing them that many of them may not respond to currently available treatments, in which case functional restoration in the context of persistent pain may improve their quality of life.

Bhatia, A., Engle, A., & Cohen, S. P. (2020). Current and future pharmacological agents for the treatment of back pain. Expert Opinion on Pharmacotherapy, 21(8), 857–861. https://doi.org/10.1080/14656566.2020.1735353