Lower Back Pain: NSAID + Muscle Relaxant No Better Than NSAID + Placebo

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Lower Back Pain: NSAID + Muscle Relaxant No Better Than NSAID + Placebo

Patients with lower back pain prescribed skeletal muscle relaxants in addition to NSAIDs report the same outcomes as placebo plus NSAIDs, new research shows.

“Combining a skeletal muscle relaxant with an NSAID does not confer any additional benefit,” Lorena Abril, MD, Montefiore Medical Center, New York City, told Medscape Medical News in an interview following her abstract presentation at the annual American College of Emergency Physicians (ACEP) online congress.

There are 2.6 million visits to emergency departments in the US annually for lower back pain, Abril said in her presentation. One third of patients report persistent back pain and 1 in 5 report limitations in activity, she explained.

Acute lower back pain “is generally considered a condition with a favorable prognosis, regardless of treatment,” Abril said. The current American College of Physicians guideline for noninvasive treatment of acute, subacute and chronic low back pain (LBP), published in 2017, recommends that if a pharmacologic treatment is desired, NSAIDs or skeletal muscle relaxants (SMRs) should be used. But “no pharmacological treatment…has been shown to provide a moderate or large effect on pain or function in patients with acute low back pain,” Abril said.

Nonpharmacologic treatment, including superficial heat, massage, acupuncture, or spinal manipulation, is initially recommended for most patients with acute or subacute low back pain, Abril said. “This is an interesting and important topic for future research, starting with the need for validated, properly described and standardized methods of measuring and reporting clinical outcomes, which is a major limitation of the literature.”

“Finding a solution,” she added, “is a challenge that we hope can be solved soon.”

American College of Emergency Physicians (ACEP) 2020: Abstract 15. Presented October 24, 2020.

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