Combining either cyclobenzaprine or oxycodone/acetaminophen with naproxen does not improve acute, nontraumatic, nonradicular low back pain for patients presenting to the emergency department, according to a study published in the October 20 issue of JAMA. 


Benjamin W. Friedman, MD, MS, and colleagues randomly assigned 323 patients who visited the emergency department for acute low back pain to a 10-day course of naproxen (20 500-mg tablets, taken twice daily) with 1 of 3 treatments added: placebo (n=107; 60 tablets); cyclobenzaprine (n=108; 1 or 2 5-mg tablets every 8 hours as needed); or oxycodone/acetaminophen (n=108; 1 or 2 tablets of oxycodone at 5 mg and acetaminophen at 325 mg every 8 hours as needed). The researchers found that measures of pain, functional impairment, and use of health care resources were not different between the groups at 1 week or 3 months later.


However, all the regimens did improve low back pain. At 1-week follow-up, nearly two-thirds of the study participants had clinically significant improvement in low back pain and function. At that point, 40% of the group reported moderate or severe pain, approximately 50% reported functional impairment, and nearly 60% were still using medication. At the 3-month follow-up, nearly 25% reported moderate or severe pain and were using medications, although less than 3% were using an opioid.