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Add-on diclofenac better than monotherapy for managing acute lower back pain

08 Oct 2019

Using diclofenac in combination with TPC (thiamine, pyridoxine and cyanocobalamin) offers superior analgesic effect than diclofenac monotherapy in the management of acute lower back pain (LBP), according to a systematic review and meta-analysis.

Researchers searched multiple online databases for studies evaluating the efficacy of diclofenac used with TPC vs alone (control) for pain management in patients with acute or chronic LBP (primary or secondary; of mild, moderate or severe intensity; and nociceptive, neuropathic or nociplastic in nature). They evaluated the risk of bias regarding randomization, allocation concealment, blinding, incomplete outcome data, selective reporting and other biases.

The search yielded five studies involving 1,108 adult patients in total. Four of these studies used the primary outcome of premature discontinuation of treatment due to complete relief of pain. The quality of evidence was rated as moderate-to-high.

Pooled data showed that more patients who received the combination therapy vs diclofenac monotherapy achieved the primary outcome (189 of 548 vs 128 of 560 patients; risk difference, 12 percent, 95 percent CI, 4–20; p=0.003; relative risk, 1.52, 1.19–1.93; p=0.0007).

Patients who received diclofenac plus TPC were 87 percent as likely as those treated with diclofenac monotherapy to achieve pain relief (odds ratio, 1.87, 1.28–2.72; p=0.001; number needed to treat to benefit, 9, 6–16).

The researchers noted the need for more studies to confirm the safety of diclofenac plus TPC, as well as to examine TPC as a new analgesic adjuvant therapy in several types of pain such as mixed pain syndromes, osteoarthritis, postoperative pain and cancer, among others.  

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Most Read Articles
6 days ago
Immobilization or disuse of the forearm leads to impairment in the ability of a protein-rich meal to promote positive muscle amino acid balance, which is aggravated by dietary lipid oversupply, suggests a study. Disuse also lowers postprandial forearm amino acid uptake, but this is not exacerbated under high-fat conditions.
18 May 2020
Glucagon-like peptide-1 receptor agonists (GLP-1RA) are more effective than basal insulin in the management of total (TC) and low-density lipoprotein cholesterol (LDL-C), reveals a recent study.
17 May 2020
Increased coffee consumption among regular drinkers is associated with higher estimated glomerular filtration rate and confers protection against the risk of chronic kidney disease stages G3–G5 and albuminuria, as shown in a study.
Jairia Dela Cruz, 16 May 2020
Excess weight, greater abdominal fat, inflammation and low physical performance can all contribute to insulin resistance in middle-age Singaporean women, and these variables explain why the condition is more common among women of Chinese than Malay and Indian ethnicities, a study has found.