R.E.B.E.L.EM - December 7, 2015
Article: Freidman BW, et al. Naproxen with Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Lower Back Pain: A Randomized Clinical Trial. JAMA. 2015; 314(15): 1572-1580. 26501533
Clinical Question: Does combining either muscle relaxants or opioids to a regimen of NSAIDs improve functional outcomes and pain in patients with acute LBP?
Authors Conclusions: “Among patients with acute, non-traumatic, non-radicular LBP presenting to an ED, adding cyclobenzaprine or oxycodone/acetaminophen to naproxen alone did not improve functional outcomes or pain at 7 days. These findings do not support the use of these additional medications in this setting.”
Our Conclusions: Naproxen monotherapy is sufficient for medical management of acute non-traumatic, non-radicular LBP. Adding cyclobenzaprine or oxycodone/APAP was not shown to have any benefit in pain or functional outcomes both short and long term. Patients may in fact have more adverse outcomes from adding these medications to the mix. Keep in mind the individual patient’s current medication regimen, as this study did not look at outcomes for patients already on NSAIDs at the time of enrollment.
Potential to Impact Current Practice: In the right patient this can be brought to clinical practice immediately, leading to less polypharmacy and less adverse medication effects.
Bottom Line: Addition of either cyclobenzaprine or oxycodone/APAP to naproxen did not improve pain or functional outcomes in patients with acute LBP.
http://rebelem.com/what-is-the-role-of-muscle-relaxants-or-opiates-in-the-treatment-of-acute-non-traumatic-lbp/