According to a recent meta-analysis published in The Clinical Journal of Pain, combination pharmacotherapy is superior to placebo or monotherapy in the management of pain and disability for patients with chronic low back pain, but not for those with acute back pain. However, combination pharmacotherapy also carries a significantly higher risk for adverse effects compared with placebo and monotherapy.
Researchers conducted a meta-analysis of 12 randomised controlled trials (RCTs) comparing combination pharmacotherapy and monotherapy or placebo in low back pain, identified through a literature search on the PubMed, Embase, and Cochrane library databases.
The pooled results showed that for chronic low back pain, combination pharmacotherapy was more effective in pain relief and function improvement compared with placebo (SMD, -0.50; P<.001;) and (SMD, -0.27; P<.001), respectively. Combination therapy also showed improved pain relief compared with monotherapy (SMD, -0.82; P<.001).
For acute low back pain, combination pharmacotherapy did not outperform monotherapy for pain relief and functional improvement. Moreover, there was a significantly higher risk of adverse effects with combination pharmacotherapy compared with placebo and monotherapy, (RR, 1.80; P<.05) and (RR, 1.44; P<.05), respectively.
“Combination pharmacotherapy is associated with the risk for adverse effects compared with monotherapy or placebo. Hence, clinical use of combination pharmacotherapy for treating LBP should be accompanied by vigilant risk-benefit assessment,” the authors said.