Low back pain: no added functional benefit with paracetamol add-on vs ibuprofen only

Takeaway

• For patients with low back pain (LBP), paracetamol and ibuprofen combined did not improve functional capacity at 1 week vs ibuprofen and placebo.

Why this matters

• Nonsteroidal anti-inflammatory medications frequently fail to deliver adequate pain relief to this population.
• Studies of adding oxycodone, muscle relaxants, or diazepam to ibuprofen have been disappointing.
• Whether adding paracetamol to ibuprofen is helpful has been unclear.

Key results

• Median scores on Roland-Morris Disability Questionnaire (RMDQ):
  • Baseline: 18.5 (24 indicating maximum impairment).
  • At 1 week: 2.
• Mean improvement in score at 1 week vs emergency department (ED) visit:
  • Ibuprofen/paracetamol: 11.1 (standard deviation [SD], 10.7).
  • Ibuprofen/placebo: 11.9 (SD, 9.7).
  • Between-group difference: 0.8 (95% CI, −3.0 to 4.7).
• At 1 week, 28% of each group reported moderate or severe pain.

Study design

• Randomised double-blind 2-ED study of adults presenting with <2 weeks of acute musculoskeletal LBP and functional impairment (n=120).
• Prior to discharge home, patients were randomly assigned to ibuprofen+paracetamol vs ibuprofen+placebo for 1 week.
• Outcome: improved score on 24-item RMDQ (5-point change is clinically significant).
• Funding: Harold and Muriel Block Institute for Clinical and Translation Research at Einstein and Montefiore.

Limitations

• Patient population was of low socioeconomic status; results may not generalise to other populations.