“If there’s a pill, then pharmaceutical companies will find a disease for it.”
– Jeremy Laurance
A recent study conducted at an urban health care center (Friedman et al. 2017) compared outcomes for diazepam in conjunction with naproxen against naproxen alone for acute, non-traumatic, non-radicular lower back pain. For lower back pain, common treatment regimens include NSAID therapy and benzodiazepine for muscle relaxation. The evidence behind NSAID therapy has been better established than that for benzodiazepine therapy. The question arises whether diazepam improves outcomes.
In this particular study, patients were given naproxen 500 bid prn for lower back pain (20 tablets). Additionally, patients were given either diazepam (or a placebo) to also be taken bid prn pain (28 tablets). The primary outcome of interest was improvement during the week after discharge from the ER according to a standardized disability score. This single-site, randomized, double blind study involved 114 patients over a nine-month period beginning in June 2015. The evidence for improvement in outcomes with diazepam was weak. Separately, other medications like cyclobenzaprine, corticosteroids, oxycodone/acetaminophen, and acetaminophen alone have not been shown to confer significant benefit in this same patient population (Friedman et al. 2015, Friedman et al. 2006, Williams et al. 2014).
So what’s the bottom line here? Consider omitting diazepam for you next lower back pain patient!
Stay up to date on this topic and more by following Benjamin Friedman on Twitter @benjaminbwf.
References
Friedman, Benjamin W., et al. “Diazepam Is No Better Than Placebo When Added to Naproxen for Acute Low Back Pain.” Annals of Emergency Medicine, 2017, in press. doi:10.1016/j.annemergmed.2016.10.002.
Friedman, Benjamin W., et al. “Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial.” JAMA 314.15 (2015): 1572-1580.
Friedman, Benjamin W., et al. “Parenteral corticosteroids for Emergency Department patients with non-radicular low back pain.” The Journal of emergency medicine 31.4 (2006): 365-370.
Williams, Christopher M., et al. “Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial.” The Lancet 384.9954 (2014): 1586-1596.
Image taken from teendrugrehabs.com.
