Pharmacotherapy for Low Back Pain and Sciatica: A Narrative Review

Abstract

Low back pain has several etiologies. Appropriate treatment should be selected following the etiology and pathology of the pain. Various pharmacotherapeutic options are available for low back pain, and many systematic reviews have been published on the efficacy and safety of the different available pharmacotherapies. However, these reports were mostly based on the evidence from placebo-controlled randomized controlled trials, and their conclusions may not necessarily be consistent with the outcomes observed in actual clinical practice; therefore, we conducted a comprehensive narrative review of the existing evidence on the efficacy or effectiveness of pharmacotherapies for low back pain and sciatica. This narrative review was performed by systematically collecting the relevant literature, including recent active-controlled randomized controlled trials and observational studies. The evidence obtained in this review conformed to the recommendations of the current guidelines for low back pain; however, given that the evidence seemed insufficient for some pharmacotherapies, a continued accumulation of evidence and knowledge is warranted. We hope that this review paper will help clinicians and spine surgeons select appropriate medications on the basis of the pathology of the patient's pain.