Naproxen and Lower Back Pain
Written by Editor   
Monday, November 30, 2015 08:36 AM

Among patients with acute, nontraumatic, nonradicular lower back pain (LBP) presenting to the emergency department (ED), adding cyclobenzaprine or oxycodone/acetaminophen (Percocet) to naproxen therapy did not improve functional outcomes or pain at 1-week follow-up.  "These findings do not support the use of these additional medications in this setting."

Opioids, when combined with naproxen, are not more effective than naproxen alone for the majority of patients with low back pain. We demonstrated that adding cyclobenzaprine or oxycodone/acetaminophen to naproxen is unlikely to benefit the patient. 

Measures of pain, functional impairment and use of healthcare resources were not different between the study groups at 7 days or at 3 months after the ED visit.  On the other hand, 40% of the cohort reported pain that was moderate or severe and half reported functional impairment 1 week after the ED visit, and 60% of the study participants said they were still using medication after 1 week.

LBP is responsible for more than 2.7 million visits to U.S. EDs annually. In most cases, patients are treated with nonsteroidal anti-inflammatory drugs, acetaminophen, opioids, or skeletal muscle relaxants, often in combination.

"Pain outcomes for these patients are generally poor," wrote the authors. One week after an ED visit, 70% of patients reported persistent back pain-related functional impairment and 69% reported continued use of analgesics, they noted. After 3 months, some 48% reported functional impairment and 46% reported persistent analgesic use. This included 19% who still required opioids.

Remaining active leads to a better outcomes than bed rest, said the investigators, although they acknowledged that complementary therapies such as acupuncture, yoga, and massage have been inadequately studied in an acute LBP population.

All participants were given 20 tablets of naproxen, 500 mg, to be taken twice a day. They were randomized to receive either 60 tablets of placebo, 5 mg cyclobenzaprine, or 5 mg oxycodone/ 325 mg acetaminophen.

Participants were instructed to take one or two of these tablets every 8 hours, as needed.