Ibuprofen+Acetaminophen is no better than Ibuprofen alone for low back pain
Bronx, NY: Acetaminophen+Ibuprofen versus ibuprofen alone did not improve disability or pain one week after discharge in patients with acute low back pain (LBP), according to a recent study published in the journal Academic Emergency Medicine.
LBP patients are often treated with nonsteroidal anti‐inflammatory drugs (NSAIDs) which are modestly effective for LBP. But, many LBP patients continue to suffer despite treatment with these medications. Benjamin W. Friedman, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, and colleagues compared functional outcomes and pain, 1 week after discharge from the emergency department (ED) in LBP patients randomized to 1-week course of acetaminophen+ibuprofen versus ibuprofen+placebo.
This randomized, double-blind study was conducted in two urban EDs. Patients presenting with acute, nontraumatic, nonradicular LBP of no more than 2 weeks' duration were eligible for enrollment immediately prior to discharge from an ED if they had a score > 5 on the Roland Morris Disability Questionnaire (RMDQ) -- a 24‐item validated instrument, indicating more than minimal functional impairment. All the 120 patients who met selection criteria and randomized were given a standardized 10‐minute LBP educational session prior to discharge.
The primary outcome was an improvement on the RMDQ between ED discharge and 1 week later. One secondary outcome was pain intensity, as measured on a 4‐point descriptive scale (severe, moderate, mild, none) at 1 week.
Key findings of the study include:
- By 1 week after the ED visit, patients randomized to ibuprofen plus placebo reported a mean (±SD) improvement in the RMDQ of 11.9 (±9.7), while those randomized to ibuprofen plus acetaminophen reported a mean (±SD) improvement of 11.1 (±10.7).
- The 95% CI for the between‐group difference of 0.8 was −3.0 to 4.7.
- At 1 week, moderate or severe pain was reported by 15 of 53 (28%) patients in the ibuprofen plus placebo group and 16 of 57 (28%) patients in the ibuprofen plus acetaminophen group.
"Among ED patients with acute, nontraumatic, nonradicular LBP, adding acetaminophen to ibuprofen does not improve outcomes within 1 week," concluded the authors.
The study, "Ibuprofen Plus Acetaminophen Versus Ibuprofen Alone for Acute Low Back Pain: An Emergency Department–based Randomized Study," is published in the journal Academic Emergency Medicine.