A Randomized, Double-Blind, Placebo-Controlled Trial of Naproxen With or Without Orphenadrine or Methocarbamol for Acute Low Back Pain

Friedman, Benjamin W.; Cisewski, David H.; Irizarry, Eddie; Davitt, Michelle; Solórzano, Clemencia; Nassery, Adam; Pearlman, Scott; White, Deborah; Gallagher, E. John

doi:10.1016/j.annemergmed.2017.09.031

Cited by 53 publications

(40 citation statements)

References 19 publications

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“…In one study, patients were randomized to treatment with 7 days of naproxen + diazepam or naproxen + placebo (June 2015–February 2016). In the other study, patients were randomized to treatment with 7 days of naproxen + placebo, naproxen + orphenadrine, or naproxen + methocarbamol (March 2016–February 2017) . The study protocols were identical, with the exception of slightly different exclusion criteria, which were necessary because of slightly different contraindications to investigational medications.…”

Section: Methodsmentioning

confidence: 99%

“…Low back pain (LBP) causes more than 2.5 million visits to U.S. emergency departments (EDs) annually . Among the subset of ED patients who present with acute LBP, most will recover, although 10% to 20% of this group report moderate or severe LBP 3 months later and 30% report LBP‐related functional impairment . These patients are at risk for chronic LBP, a debilitating, highly prevalent condition that erodes quality of life and accounts for more than $600 billion in direct and indirect costs annually .…”

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confidence: 99%

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Pain One Week After an Emergency Department Visit for Acute Low Back Pain Is Associated With Poor Three‐month Outcomes

Friedman

Conway

Campbell

et al. 2018

Academic Emergency Medicine

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More than one-third of patients reported functional impairment 3 months after an ED visit for acute, nontraumatic, nonradicular LBP. Moderate or severe LBP was less common, reported in about half as many patients (16%). Of the three hypothesized predictor variables, only persistent pain at 1 week was independently associated with poor outcomes at 3 months. Despite its important role in the outpatient setting, the STarT Back Tool was not associated with poor outcomes in this ED cohort.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Pain One Week After an Emergency Department Visit for Acute Low Back Pain Is Associated With Poor Three‐month Outcomes

Friedman

Conway

Campbell

et al. 2018

Academic Emergency Medicine

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“…NSAIDs are efficacious, though only modestly, and are frequently accompanied by adverse medication effects . Adding oxycodone, diazepam, or skeletal muscle relaxants to NSAIDs does not result in improved outcomes. Generally, with the passage of time, most patients who present to an ED with acute, nonradicular LBP improve.…”

Section: Discussionmentioning

confidence: 99%

“…4 It is not yet clear if combination therapy with more than one medication can improve LBP outcomes. For a general population of patients with acute, nonradicular LBP, combining NSAIDs with oxycodone, 3 diazepam, 5 or skeletal muscle relaxants 6,7 does not improve 1-week outcome more than treatment with NSAIDs alone. Acetaminophen is often used for acute LBP, although it is unlikely to be effective when used as monotherapy.…”

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confidence: 95%

Ibuprofen Plus Acetaminophen Versus Ibuprofen Alone for Acute Low Back Pain: An Emergency Department–based Randomized Study

Friedman

Irizarry

Chertoff

et al. 2020

Academic Emergency Medicine

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Objectives Patients with low back pain (LBP) are often treated with nonsteroidal anti‐inflammatory drugs (NSAIDs). NSAIDs are modestly effective for LBP, but many patients with LBP continue to suffer despite treatment with these medications. We compared pain and functional outcomes 1 week after emergency department (ED) discharge among patients randomized to a 1‐week course of ibuprofen plus acetaminophen versus ibuprofen plus placebo. Methods This was a randomized, double‐blind study conducted in two urban EDs. Patients presenting with acute, nontraumatic, nonradicular LBP of no more than 2 weeks’ duration were eligible for enrollment immediately prior to discharge from an ED if they had a score > 5 on the Roland Morris Disability Questionnaire (RMDQ), a 24‐item validated instrument, indicating more than minimal functional impairment. All patients were given a standardized 10‐minute LBP educational session prior to discharge. The primary outcome was improvement on the RMDQ between ED discharge and 1 week later. One secondary outcome was pain intensity, as measured on a 4‐point descriptive scale (severe, moderate, mild, none) at 1 week. Results Enrollment began in October 2018. A total of 120 patients met selection criteria and were randomized. Baseline demographic characteristics were comparable between the two groups. By 1 week after the ED visit, patients randomized to ibuprofen plus placebo reported a mean (±SD) improvement in the RMDQ of 11.9 (±9.7), while those randomized to ibuprofen plus acetaminophen reported a mean (±SD) improvement of 11.1 (±10.7). The 95% CI for the between‐group difference of 0.8 was −3.0 to 4.7. At 1 week, moderate or severe pain was reported by 15 of 53 (28%) patients in the ibuprofen plus placebo group and 16 of 57 (28%) patients in the ibuprofen plus acetaminophen group (95% CI for between‐group difference of 0% = −17% to 17%). Conclusion Among ED patients with acute, nontraumatic, nonradicular LBP, adding acetaminophen to ibuprofen does not improve outcomes within 1 week.

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“…There is growing interest and research that supports the use of nonpharmacologic strategies, such as superficial heat, massage, acupuncture, spinal manipulation, or noncontrolled substance pharmacologic treatments such as nonsteroidal anti-inflammatory drug (NSAID) medications or muscle relaxants as first-line therapies. [42][43][44][45][46][47] This is echoed in the 2017 American College of Physicians (ACP) guidelines. 48 These guidelines differ from the 2007 guidelines in that acetaminophen is no longer recommended as a first-line therapy for acute muscular and radicular pain.…”

Section: Treatment Of Muscular and Radicular Painmentioning

confidence: 99%

Evaluation and Management of Neck and Back Pain

Martel

Potter

2019

Semin Neurol

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Neck and back pain are common reasons for seeking evaluation and treatment in the emergency department. Within both systems there exist several time-sensitive diagnoses that the emergency provider should be familiar with in order to prevent significant morbidity and mortality. In this article we provide a general overview of these complaints by discussing problems in a systems-based fashion as well as discussing the initial evaluation, work-up, and treatment options for these diagnoses.

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A Randomized, Double-Blind, Placebo-Controlled Trial of Naproxen With or Without Orphenadrine or Methocarbamol for Acute Low Back Pain

Abstract: Among ED patients with acute, nontraumatic, nonradicular low back pain, combining naproxen with either orphenadrine or methocarbamol did not improve functional outcomes compared with naproxen+placebo.

Cited by 53 publications

References 19 publications

Pain One Week After an Emergency Department Visit for Acute Low Back Pain Is Associated With Poor Three‐month Outcomes

Pain One Week After an Emergency Department Visit for Acute Low Back Pain Is Associated With Poor Three‐month Outcomes

Ibuprofen Plus Acetaminophen Versus Ibuprofen Alone for Acute Low Back Pain: An Emergency Department–based Randomized Study

Evaluation and Management of Neck and Back Pain

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