Oral Ibuprofen Superior To Topical Diclofenac for Acute Low Back Pain, Study Finds
Acute low back pain is a common complaint in emergency departments (EDs), often leading to discomfort and functional impairment. Nonsteroidal anti-inflammatory drugs (NSAIDs), including oral ibuprofen and topical diclofenac, are commonly used to manage musculoskeletal pain. However, the comparative efficacy of these medications in the treatment of acute nonradicular musculoskeletal low back pain remains uncertain.
A recent study was published in the journal of Annals of Emergency Medicine by Nauman K. and colleagues. A randomized, placebo-controlled double-blind study was conducted among patients aged 18 to 69 years presenting to the ED with acute, nontraumatic, nonradicular musculoskeletal low back pain. Participants were randomized to receive one of three treatments: oral ibuprofen + placebo topical gel, 1% diclofenac topical gel + oral placebo, or a combination of oral ibuprofen + 1% diclofenac topical gel. The primary outcome measure was the change in Roland Morris Disability Questionnaire (RMDQ) score between ED discharge and 2 days later.
The key findings of the study were:
• A total of 198 patients were randomized, with 36% women and a mean age of 40 years.
• The median RMDQ score at baseline indicated substantial low back-related functional impairment.
• Two days after the ED visit, patients receiving oral ibuprofen + placebo showed the greatest improvement in RMDQ score (10.1), followed by those receiving diclofenac gel + placebo (6.4), and those receiving ibuprofen + diclofenac gel (8.7).
• Oral ibuprofen was found to be more efficacious than topical diclofenac, with no additional benefit observed when diclofenac gel was co administered with ibuprofen.
• Medication-related adverse events were reported by a small percentage of patients in each treatment group, with no significant differences observed between groups.
In patients with acute nontraumatic, nonradicular musculoskeletal low back pain discharged from the ED, oral ibuprofen was more effective than topical diclofenac in improving functional impairment as measured by RMDQ scores. Furthermore, the addition of diclofenac gel to oral ibuprofen did not provide additional benefit. These findings highlight the importance of considering oral NSAIDs as the primary treatment option for acute low back pain in the ED setting. Further research may help elucidate the optimal management strategies for this common condition.
Reference:
Khankhel, N., Friedman, B. W., Baer, J., Lopez, L., Feliciano, C., Lee, S., & Irizarry, E. (2024). Topical diclofenac versus oral ibuprofen versus diclofenac + ibuprofen for emergency department patients with acute low back pain: A randomized study. Annals of Emergency Medicine. https://doi.org/10.1016/j.annemergmed.2024.01.037
