Panel findings and recommendations:
- Based on conflicting evidence of effectiveness as well as the potential for serious side effects, colchicine is not recommended for treating patients with acute low back problems.
(Strength of Evidence = B
Colchicine has been used primarily to treat acute attacks of gouty arthritis and can be administered intravenously or orally. The therapeutic objective of using the drug in patients with low back problems is to reduce inflammation and thereby reduce pain.
Of 13 articles screened, 3 RCTs met criteria for review.122
Schnebel and Simmons123
evaluated only patients with low back problems of less than 3 months' duration. Meek, Giudice, McFadden, et al.122
evaluated patients with symptoms of more than 2 months. Simmons, Harris, Koulisis, et al.124
evaluated those with symptoms lasting up to 6 months.
Evidence on Efficacy.
Schnebel and Simmons123
found no statistically significant difference between oral colchicine and a placebo, although the oral colchicine group did have significantly more diarrhea and vomiting than the placebo group. Simmons, Harris, Koulisis, et al., 124
who compared groups receiving either intravenous colchicine or intravenous saline, found significantly improved pain ratings for the colchicine group, but pain relief was short-lived (lasting from 1 hour to 2 days). Also, two patients in the colchicine group developed complications (diarrhea and a local inflammatory response). Meek, Giudice, McFadden, et al.,122
who evaluated for 1 month a group receiving one dose of intravenous colchicines followed by oral colchicine, compared with a group receiving placebo, found significantly greater pain relief in the colchicine group.
Potential Harms and Costs.
Potential complications from the use of colchicine are gastrointestinal irritation, skin problems, severe chemical cellulitis from intravenous infiltration, and bone marrow suppression with agranulocytosis.124
The expense of treatment with colchicine varies greatly, depending on whether oral or intravenous administration is used and on length of treatment.
Summary of Findings.
Research evidence is limited and conflicting on whether colchicine, given either orally or intravenously, is an effective treatment for patients with low back problems. Serious potential side effects have been reported with use of this medication.
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