Study: Sedatives, Opioids Do Not Improve Low Back Pain Outcomes

To treat acute, nontraumatic, nonradicular lower back pain, neither cyclobenzaprine (Flexeril) nor opioids were helpful additions to naproxen therapy, according to a recent study.

For their study, investigators randomized 323 participants to receive either placebo or cyclobenzaprine in conjunction with oxycodone/acetaminophen. Researchers pulled participants from an emergency department in the Bronx area of New York City.
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“Patients who presented with nontraumatic, nonradicular LBP of 2 weeks’ duration or less were eligible for enrollment upon ED discharge if they had a score greater than 5 on the Roland-Morris Disability Questionnaire (RMDQ),” explained the authors of the study.

The participants received 20 tablets of naproxen (500 mg) and were instructed to take them twice a day. All participants received either of the placebo, 5mg cyclobenzaprine or 5 mg of oxycodone/325 mg of acetaminophen.

Each patient received a standardized 10-minute educational session about lower back pain before they were discharged.  

The median interquartile range of RMDQ scores were 20 in the placebo group, 19 in the cyclobenzaprine group, and 20 in the oxycodone/acetaminophen group.

Investigators defined the interquartile range as a score from 17 to 21.

At 1 week-follow-up, researchers discovered the mean RMDQ scores had improved to 9.8 for the placebo group, 10.1 for those following cyclobenzaprine therapy, and 11.1 for patients in the oxycodone/acetaminophen group.

The investigators noted that opioids and muscle relaxants appeared to not add much in assisting non-steroidal anti-inflammatory drugs in pain relief.

“These findings do not support use of these additional medications in this setting,” they concluded.

The complete study is published in the October issue of the Journal of the American Medical Association.

-Michelle Canales Butcher

Reference:

Friedman BW, Dym AA, Davitt M I, et al. Naproxen with Cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain. JAMA. 2015 October [epub ahead of print] doi: 10.1001/jama.2015.13043.

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