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A 2022 systematic review examined nine clinical practice guidelines (CPGs) that address oral medications for non-specific LBP: American College of Physicians: Major U.S

(2004) Genetic deletion of ghrelin does not decrease food intake but influences metabolic fuel preference

Its not that you cant use them at all, just not in the same application

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Other important safety considerations include: Risk of acute pancreatitis : Seek urgent medical attention for severe, persistent abdominal pain with or without vomiting [1] Gallbladder disease : Increased risk of gallstones and related complications Diabetic retinopathy : Caution in patients with pre-existing retinopathy due to rapid improvement in blood glucose control Hypoglycaemia : Increased risk when used with insulin or sulfonylureas, which may require dose reduction of these medications Oral contraceptive interaction : Reduced effectiveness due to delayed gastric emptying