Tuesday, October 27, 2015

Low Back Pain: What's the Best Medication Approach?

Wouldn't it be great if there was a study that compared patient outcomes among several groups based on a single, common diagnosis but several potential medication regimens?  How might such a study be designed?

Perhaps you could identify 300 patients, all of whom presented in the emergency department of a hospital with acute low back pain.  We might assess their level of disability utilizing a widely used health status measure like, say, the Roland Morris Disability Questionnaire (RMDQ).  We might divide the patients into three groups based on their medication regimen:
1. Naproxen + placebo
2. Naproxen + cyclobenzaprine
3. Naproxen + oxycodone/acetaminophen

We'd make sure the initial RMDQ scores were roughly similar across all three groups.  We'd also make sure all three groups were similar demographically and that each patient received education on management of low back pain prior to discharge from the hospital.    Then we'd call the patients at the 1 week mark and the 3 month mark to re-assess their level of disability.  That would tell us which of the three various medication regimens provides for the best patient outcomes.

Such a study would be helpful, right?

Well, researchers at Montefiore Medical Center and Albert Einstein College of Medicine conducted just such a study and the results are compelling.

It appears that "take two Aleve and get some rest" may, in fact, be the best (and certainly the safest) course of action when it comes to preventing acute LBP from becoming chronic LBP.

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1 comment:

  1. Yes, there's a large subset of people with chronic LBP, including those with intermittent sciatica, who can keep symptoms under control with limiting sitting (or standing) time, frequent use of ice packs, and occasional Naproxen (or another NSAID more suitable for that individual- I'm not an MD) to control flare-ups. In addition, the results of initial and follow-up studies by a Liberty Mutual research team (Snook et al, Jnl Occ. Rehab. 12(1):13-9 · 3/2002) support the value of avoiding early morning lumbar flexion in controlling symptoms. The use of local application of ice packs, for those individuals whose symptoms respond well to that, as frequently as several times/day, (including while driving to/from MD appointments), should not be overlooked as a low-cost part of the overall treatment plan. The effectiveness of household and workplace ergonomics to reduce risk factors that aggravate chronic LBP has also been well-established (e.g., Loisel et al, in Spine, Vol. 22(24) 15 Dec. 1997).
    Ira Janowitz, PT (Ret.), MPS, CPE