People who went to the emergency department for severe low back pain did not get more comfort from opioids or muscle relaxants than non-prescription painkillers. Non-steroidal anti-inflammatory drugs (NSAIDs) by themselves, too, relieved patients as much as more potent painkillers did.
These were the findings of a new randomized clinical trial published Oct. 20 in the Journal of the American Medical Association (JAMA).
Dr. Benjamin Friedman, lead author and part of Montefiore Medical Center in New York, said the results were surprising, as opioids are generally believed to be useful in combination with NSAIDs to address acute pain in the lower back.
In the trials that involved 323 ER patients with low back pain, one-fourth received NSAIDs and opioids, while another quarter received NSAIDs and muscle relaxants. All three medications were given to another 15 percent.
Five-hundred milligrams of naproxen (NSAID) was given twice a day to all subjects, who were also assigned randomly to follow a 10-day course of a dummy pill, cyclobenzaprine (muscle relaxant), or oxycodone (opioid).
After a week and a month, patients reported similar results irrelevant of the drug taken. After a week, too, nearly two-thirds in every group saw improvements, although half reported still being functionally impaired and more than half remained medicating.
Three months post-ER visit, nearly one-fourth of the subjects said they continued to experience moderate to severe pain, but no more than three percent revealed they had taken an opioid in the last three days.
Dr. Friedman said that some of the drugs for back pain did not appear to do any good to the patients. While NSAIDS offered some relief, opioids were expected to deliver the rest but did not.
Those who cannot tolerate NSAIDs can be offered muscle relaxants as an alternative, Dr. Friedman added.
Low back pain is a very common illness that results from lifting too heavy objects, sleeping in awkward positions, experiencing minor vehicular accidents, or even failing to stretch before exercising.
Dr. Richard Deyo of Portland’s Oregon Health and Science University said these findings may raise awareness regarding the proper use of opioids or muscle relaxants for treating acute back pain to get fewer adverse effects without any apparent benefit loss.
Photo: Kurtis Garbutt | Flickr
