Adverse drug reactions and cost effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and neurotropic drugs in patients with low back pain

Objective: The objective of the study was to assess and compare the efficacy and tolerability of flupirtine versus tramadol in patients with chronic moderate low back pain (LBP). Materials and Methods: A prospective study was conducted in the outpatient department of orthopaedics at tertiary care hospital, Rajamahendravarm. After meeting the inclusion criteria, a total of 60 patients were randomly allocated to tablet flupirtine 100 mg in Group A and tablet tramadol 50 mg in Group B. The efficacy of the study drugs was assessed at baseline and the end of treatment by numerical rating scale11, visual analog scale-100 mm, physician’s, and patient’s global assessment. Statistical analysis was done using paired and unpaired t-test and data were presented as mean±standard deviation. Adverse drug reactions were monitored during the treatment. Results: The study results showed that 90% of the patients in Group A and 78% of the patients in Group B had shown a good response to their respective drugs. 30% of flupirtine group patients reported adverse drug reactions which were mild. Conclusion: Both the drugs are effective in the treatment of moderate chronic LBP, but the advantage of flupirtine was, the incidence of adverse drug reactions was less when compared to tramadol group.

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Efficacy and Safety of Duloxetine in Patients with Chronic Low Back Pain Who Used versus Did Not Use Concomitant Nonsteroidal Anti-Inflammatory Drugs or Acetaminophen: A Post Hoc Pooled Analysis of 2 Randomized, Placebo-Controlled Trials

Pain Research and Treatment ◽

10.1155/2012/296710 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Vladimir Skljarevski ◽

Peng Liu ◽

Shuyu Zhang ◽

Jonna Ahl ◽

James M. Martinez

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Pooled Analysis ◽

Analysis Of Covariance ◽

Low Back ◽

Substantial Evidence ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Post Hoc

This subgroup analysis assessed the efficacy of duloxetine in patients with chronic low back pain (CLBP) who did or did not use concomitant nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (APAP). Data were pooled from two 13-week randomized trials in patients with CLBP who were stratified according to NSAID/APAP use at baseline: duloxetine NSAID/APAP user (), placebo NSAID/APAP user (), duloxetine NSAID/APAP nonuser (), and placebo NSAID/APAP nonuser (). NSAID/APAP users were those patients who took NSAID/APAP for at least 14 days per month during 3 months prior to study entry. An analysis of covariance model that included therapy, study, baseline NSAID/APAP use (yes/no), and therapy-by-NSAID/APAP subgroup interaction was used to assess the efficacy. The treatment-by-NSAID/APAP use interaction was not statistically significant () suggesting no substantial evidence of differential efficacy for duloxetine over placebo on pain reduction or improvement in physical function between concomitant NSAID/APAP users and non-users.

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Non-steroidal anti-inflammatory drugs for low back pain

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd000396.pub3 ◽

2008 ◽

Cited By ~ 83

Author(s):

Pepijn DDM Roelofs ◽

Rick A Deyo ◽

Bart W Koes ◽

Rob JPM Scholten ◽

Maurits W van Tulder

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Low Back ◽

Inflammatory Drugs ◽

Anti Inflammatory

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Nonsteroidal Anti-Inflammatory Drugs for Low Back Pain

Spine ◽

10.1097/00007632-200010010-00013 ◽

2000 ◽

Vol 25 (19) ◽

pp. 2501-2513 ◽

Cited By ~ 176

Author(s):

Maurits W. van Tulder ◽

Rob J. P. M. Scholten ◽

Bart W. Koes ◽

Rick A. Deyo

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Low Back ◽

Inflammatory Drugs ◽

Anti Inflammatory

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Efficacy of non-steroidal anti-inflammatory drugs for low back pain: a systematic review of randomised clinical trials

Annals of the Rheumatic Diseases ◽

10.1136/ard.56.4.214 ◽

1997 ◽

Vol 56 (4) ◽

pp. 214-223 ◽

Cited By ~ 77

Author(s):

B. W Koes ◽

R. J P M Scholten ◽

J. M A Mens ◽

L. M Bouter

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Low Back Pain ◽

Back Pain ◽

Randomised Clinical Trials ◽

Low Back ◽

Inflammatory Drugs ◽

Anti Inflammatory

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Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-103596 ◽

2021 ◽

pp. bjsports-2020-103596

Author(s):

Silvia Gianola ◽

Silvia Bargeri ◽

Gabriele Del Castillo ◽

Davide Corbetta ◽

Andrea Turolla ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Meta Analysis ◽

Muscle Relaxants ◽

Low Back ◽

Eligibility Criteria ◽

Experienced Pain ◽

Inflammatory Drugs

ObjectiveTo assess the effectiveness of interventions for acute and subacute non-specific low back pain (NS-LBP) based on pain and disability outcomes.DesignA systematic review of the literature with network meta-analysis.Data sourcesMedline, Embase and CENTRAL databases were searched from inception until 17 October 2020.Eligibility criteria for selecting studiesRandomised clinical trials (RCTs) involving adults with NS-LBP who experienced pain for less than 6 weeks (acute) or between 6 and 12 weeks (subacute).ResultsForty-six RCTs (n=8765) were included; risk of bias was low in 9 trials (19.6%), unclear in 20 (43.5%), and high in 17 (36.9%). At immediate-term follow-up, for pain decrease, the most efficacious treatments against an inert therapy were: exercise (standardised mean difference (SMD) −1.40; 95% confidence interval (CI) −2.41 to –0.40), heat wrap (SMD −1.38; 95% CI −2.60 to –0.17), opioids (SMD −0.86; 95% CI −1.62 to –0.10), manual therapy (SMD −0.72; 95% CI −1.40 to –0.04) and non-steroidal anti-inflammatory drugs (NSAIDs) (SMD −0.53; 95% CI −0.97 to –0.09). Similar findings were confirmed for disability reduction in non-pharmacological and pharmacological networks, including muscle relaxants (SMD -0.24; 95% CI -0.43 to -0.04). Mild or moderate adverse events were reported in the opioids (65.7%), NSAIDs (54.3%) and steroids (46.9%) trial arms.ConclusionWith uncertainty of evidence, NS-LBP should be managed with non-pharmacological treatments which seem to mitigate pain and disability at immediate-term. Among pharmacological interventions, NSAIDs and muscle relaxants appear to offer the best harm–benefit balance.

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