Opioid Added to Prescription NSAID Provides No Additional Help in Low Back Pain

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Naproxen alone appears to provide as much relief for low back pain as naproxen plus oxycodone/acetaminophen or cyclobenzaprine.
Naproxen alone appears to provide as much relief for low back pain as naproxen plus oxycodone/acetaminophen or cyclobenzaprine.

HealthDay News -- Naproxen alone appears to provide as much relief for low back pain as naproxen plus oxycodone/acetaminophen or cyclobenzaprine, according to research published in the Journal of the American Medical Association.

Benjamin Friedman, MD, an associate professor of emergency medicine at Montefiore Medical Center and the Albert Einstein College of Medicine in New York City, and colleagues randomly assigned 323 patients who came to an emergency department with lower back pain to 10 days of treatment with one of three combinations. The combinations included 500 mg of naproxen plus a placebo pill; 500 mg of naproxen plus 5 mg of cyclobenzaprine; or 500 mg of naproxen plus 5 mg of oxycodone and 325 mg of acetaminophen. All of the study participants were given a 10-minute education session on low back pain before leaving the hospital.

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Adding the opioid or muscle relaxant to naproxen therapy didn't help pain or function any more than naproxen alone, Friedman told HealthDay. "Nearly 50% of patients were still suffering one week later. Nearly 25 percent of the patients were still suffering three months later," he said. But regardless of the treatment, nearly two-thirds of patients had significantly less pain and better movement one week after starting treatment, the investigators found.

"Among patients with acute, nontraumatic, nonradicular low back pain presenting to the emergency department, adding cyclobenzaprine or oxycodone/acetaminophen to naproxen alone did not improve functional outcomes or pain at one-week follow-up," the authors concluded. "These findings do not support use of these additional medications in this setting."

Reference

Friedman B, Dym A, Davitt M et al. Naproxen With Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial. JAMA. 2015;314(15):1572-1580. doi:10.1001/jama.2015.13043.

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