Drug combos do not improve acute low back pain

by Bruce Sylvester: Emergency room patients who report acute, lower back pain do not appear to benefit from adding either oxycodone/acetaminophen or the muscle relaxant cyclobenzaprine to naproxen monotherapy, researchers reported in the October 20 issue of JAMA, the Journal of the American Medical Association.

Benjamin Friedman, M.D., associate professor, Albert Einstein College of Medicine, Bronx, N.Y., and colleagues randomized 323 subjects presenting at an emergency department with nontraumatic, nonradicular lower back pain of less than 2 weeks duration to a 10-day course of naproxen-plus-placebo (n = 107), naproxen-plus-cyclobenzaprine (5 mg) (n = 108) or naproxen-plus-oxycodone, 5 mg/acetaminophen, 325 mg (n = 108).

Subjects took 1 or 2 of the non-naproxen tablets every 8 hours, as needed. They took naproxen, 500 mg, twice daily.

Patients also participated in a 10-minute lower back pain educational session before discharge.

The investigators reported that naproxen combined with oxycodone/acetaminophen and naproxen combined with cyclobenzaprine did not provide greater improvement in pain relief or in functional outcomes compared with naproxen combined with placebo.

At 7 days and at 3 months after the emergency department visit, standard measures of pain, functional impairment, and use of health care resources did not show differences in improvement between the treatment groups.

Regardless of treatment, almost two-thirds of the subjects achieved significantly less pain and better movement one week after starting treatment, the investigators reported.

“These findings do not support the use of these additional medications in this setting,” the authors concluded.