There is a lack of evidence supporting the benefits of combination drug therapy over monotherapy for the management of low back pain and sciatica, according to a systematic review published in the Journal of Pain.

The investigators conducted a systematic review of 27 randomized studies in which patients with acute or chronic low back or sciatica were treated with a combination of 2 or more different drugs. Primary outcomes were reductions in pain intensity and disability.

Most combination therapies were found to have no or small effect on pain and disability. For 1 combination (buprenorphine plus pregabalin), a clinically significant effect was found for immediate and short-term relief of chronic back pain. However, the quality of evidence for this study was deemed to be low. Combination therapies were not found to raise the risk for serious adverse events. Of the 6 combination therapies for which participants reported a serious adverse event, none had a statistically significant increase when compared with monotherapy or placebo.

Taking into consideration the low quality of evidence and small number of studies, the review authors concluded that there is no clear evidence in favor of combination drug therapy for the management of low back pain or sciatica.

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Risk for bias was an important limitation to this review, as the panelists noted that many studies did not disclose funding or sponsorship or had authors who were consultants for pharmaceutical companies.

“The appropriate use of combination therapy in clinical practice should consider available evidence on patient outcomes to determine if the benefits outweigh the risks,” concluded the investigators.

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Reference

Mathieson S, Kasch R, Maher CG, et al. Combination drug therapy for the management of low back pain and sciatica; systematic review and meta-analysis [published online July 2, 2018]. J Pain. doi: 10.1016/j.jpain.2018.06.005