DMARDs may be underused for low back pain

(HealthDay)—Disease-modifying antirheumatic drugs (DMARDs) may be underutilized for treatment of low back pain (LBP), according to a review published online June 1 in Pain Practice.

Khalid M. Malik, M.D., from Northwestern University in Chicago, and colleagues reviewed the literature to determine the role of DMARDs in the treatment of LBP.

The researchers found that current DMARD use for LBP is limited in scope and is characterized by isolated use and empiric selection of drugs from a range of available DMARDs. Arbitrary selection characterizes the dose, frequency, and route of drug administration—a deviation from treatment protocols proposed for the management of other inflammatory conditions. The published literature in this area is of low quality, either prohibiting conclusive results or demonstrating only short-term efficacy of these medications.

"Based on the findings of this review, we recommend that the future DMARD use for LBP is initially limited to patients with debilitating disease who are unresponsive to conventional treatments," the authors write. "When used for treatment of LBP, combination systemic DMARD therapy should be based on a protocol driven approach already in place for other chronic inflammatory conditions."