What is the most effective pharmacologic treatment for chronic low back pain?
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Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment for chronic low back pain (strength of recommendation [SOR]: A, based on meta-analysis), but acetaminophen should not be forgotten due to its favorable safety profile and low cost. Opioids or tramadol (Ultram) may be used, but are no more effective than placebo or nonopioids. They are a second option for short-term therapy, and have been studied up to 16 weeks for opioids and up to 12 weeks for tramadol (SOR A, based on meta-analysis), but evidence currently does not exist for their efficacy in long-term use.
Evidence-based practice 13, no. 05 (2010): 01-02