For Lower Back Pain, Less Meds May Mean More Relief

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Screen Shot 2015-10-22 at 11.21.52 AMAccording to a recent report in JAMA, lower back pain sends over 2.5 million Americans to hospital emergency departments every year. Such pain, when not due to radiculopathy (i.e. a pinched nerve or sciatica) might be treated with several different drugs, or a combination of pharmaceuticals. These include naproxen/Aleve (a non-steroidal anti-inflammatory or NSAID), cyclobenzaprine (a muscle relaxant), or a combination of drugs such as oxycodone (an opioid narcotic plus acetaminophen).

A group of researchers, led by Dr. Benjamin Friedman from Albert Einstein College of Medicine in the Bronx, NY investigated the extent to which drugs or combinations of drugs were most effective at reducing pain and improving function at one week and 3 months after a visit to the emergency room for acute occurrence of lower back pain (LBP).

There were 323 patients who had presented to the emergency department with nonradicular LBP which had lasted 2 weeks or less, who were included in the study. These patients were randomly assigned to one of 3 groups: group one was given a placebo, group 2 received cyclobenzaprine, and group 3 got a combination of oxycodone and acetaminophen. All, including those given the placebo, also took naproxen and instructed to take 500 mg twice per day.

One week and 3 months after the ER visit, the patients in the 3 groups reported on levels of pain and degree of functional impairment. There were no differences between the groups with respect to either measure. Indeed, at the 7 day point, nearly two thirds of them reported significant improvement in both.

Thus, simply taking naproxen, was as effective in alleviating pain and restoring function as was the use of the muscle relaxant or the opioid combination. In an interview, Dr. Friedman noted that "Many patients have already taken NSAIDs for LBP before they arrive in the ED. Some patients may have taken insufficient doses at incorrect intervals and could be instructed to optimize their NSAID regimen. But for those patients who have already optimized their NSAID regimen, there are no additional evidence-based medical therapies available."