A comparative study of aceclofenac versus etoricoxib in the management of acute low back pain in a tertiary care hospital

Abstract

Background: The aim of management of acute low back pain is to alleviate the pain quickly and improve functional ability. Non-steroidal anti-inflammatory drugs are the first line of treatment. The challenge lies in deciding which NSAIDs will provide greater symptomatic relief, while also being cost-effective. Objective: To compare the effectiveness of aceclofenac and etoricoxib in the management of acute low back pain. Methods: This prospective, open label, observational study was conducted at a tertiary care hospital. Patients over 18 years of age and presenting with low back pain of less than 6 weeks duration were enrolled in the study. Fifty patients with non-specific low back pain were randomized into two groups: Group A received aceclofenac (2 mg/kg) twice a day and Group B received etoricoxib (1 mg/kg) twice a day for 1 week. The Numerical Rating Scale (NRS) and Oswestry Low Back Disability Index (ODI) determined the clinically meaningful outcomes. Results: The decrease in pain intensity in Group A was 52.27%, while in Group B it was 62.53%. However, the decrease in pain scores between the groups was not statistically significant (p ¼ .3795). Improvement in functional ability in Group A and Group B was 57.01% and 61.48%, respectively. However, this improvement between the groups was not statistically significant (p > .999) at the end of 1 week. The average cost-effectiveness ratio indicated that etoricoxib was the dominant treatment over aceclofenac. Therefore, etoricoxib was found to be the cost-effective option for short-term pain relief in acute low back pain for 1 week. Conclusion: Both aceclofenac and etoricoxib were clinically effective in reducing the pain intensity and in improving functional ability. However, etoricoxib was found to be the cost-effective intervention.

The Efficacy and Safety of a Combination of Thiocolchicoside and Etoricoxib in Low Back Pain (ESCoTEL): A Randomized Active-Controlled Trial

“…In the study population of this trial, the age group mostly affected by LBP was 41-50 years, similar to that observed in earlier studies from India [14]. The results of this study are also in agreement with a recent report wherein LBP burden was shown to peak between 40 and 50 years, as well as data reported in GBD 2017 wherein YLDs were found to peak at 45-49 years of age [15].…”

“…Age-standardized prevalence of LBP and YLDs was reported to be higher in females based on GBD 2017 [15]. A female preponderance was also observed in this study as well as in earlier studies on acute LBP [5,14] and in a systematic review from India [4].…”

“…On the contrary, no adverse events were encountered in this study. Placebo-controlled trials have previously shown a significant reduction in pain scores upon treatment with etoricoxib [16,17] in patients with chronic pain; the efficacy of etoricoxib was also proven by other studies in chronic LBP [18] and acute LBP [14]. Earlier trials of thiocolchicoside have proven its efficacy/safety with a significant advantage over comparators used [19][20][21][22].…”

“…In this study, we followed subjects for 28 days which is longer than the earlier studies from India that evaluated patients for seven days [5,14]. Further, we enrolled subjects from two study sites while the earlier studies were based on data collected from single centers [5,14].…”

Physical therapy for acute and sub-acute low back pain: A systematic review and expert consensus

“…6 However, about 20% of acute LBP patients have persistent pain after 12 weeks and progress to chronic LBP. 7 According to the Global Burden of Disease 2016 Disease and Injury Incidence and Prevalence Collaborators, the number of years lived with disability of patients with LBP increased by 18% between 2006 and 2016. 8 In Germany, the annual direct medical expenses on LBP exceeded 7000 € per person.…”