Single side lower back pain

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The publisher's final edited version of this article is available at Ann Emerg Med See other articles in PMC that cite the published article. Abstract Objective In US EDs, low back pain patients are often treated with non-steroidal anti-inflammatory drugs and muscle relaxants. Methods This was a randomized, double-blind, comparative effectiveness trial conducted in two urban EDs.

Patients presenting with acute, non-traumatic, non-radicular low back pain were enrolled.

single side lower back pain

All patients were given 14 tablets of naproxen mg, to be taken twice a day, as needed for low back pain. Additionally, patients were randomized to receive a one week supply of orphenadrine mg, to be taken twice a day as needed, methocarbamol mg, to be taken as one or two tablets, three times per day as needed or placebo.

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Flirten schweizerdeutsch patients received a standardized single side lower back pain minute low back pain educational session prior to discharge. Results patients were randomized. Baseline demographic characteristics were comparable. None of the between group differences surpassed our threshold for clinical single side lower back pain. Introduction Background Low back pain causes 2.

Non-steroidal anti-inflammatory drugs NSAID are more efficacious single side lower back pain placebo with regard to low back pain relief, global improvement, and requirement of analgesic medication 5 but are insufficient treatment for as many as half of all ED low back pain patients, who continue to suffer during the days after ED discharge despite use of NSAIDs.

Treatment of low single side lower back pain pain with multiple concurrent medications is common in the ED--emergency physicians often prescribe skeletal muscle relaxants or opioids in combination with NSAIDs. Two specific skeletal muscle relaxants, orphenadrine and methocarbamol, are each used in more thanU.

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ED visits for low back pain annually, although scant evidence exists to determine the appropriateness of this approach. The mechanism of action is not understood.

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Efficacy in low back pain may be related to non-specific analgesic properties. The mechanism of action of methocarbamol has also not been established.

Its efficacy is thought to be related to CNS effects rather than direct effects on skeletal muscles. Goals of this investigation Given the poor pain and functional outcomes that persist beyond an ED visit for acute low back pain, we conducted a clinical trial to determine whether combining either orphenadrine or methocarbamol with an NSAID is more effective than NSAID monotherapy for the treatment of acute, non-traumatic, non-radicular low back pain.

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Methods Study design and setting This was a randomized, double-blind, comparative effectiveness study, in which we enrolled ED patients with musculoskeletal low single side lower back pain pain at the time of discharge and followed them by telephone seven days and three months later.

Every patient received standard-of-care therapy, consisting of naproxen and a brief low back pain educational session. Patients were then randomized to orphenadrine, methocarbamol, or placebo. Written consent to participate was obtained for all study participants.

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Enrollment commenced in March and continued for 11 months. Salaried, full-time, bilingual English and Spanish technician-level research associates, staffed the EDs 18—24 hours per day, seven days per week during the study period.

Selection of participants Our goal was to include a broad representation of patients with musculoskeletal back pain who would potentially respond to the investigational medications. The presence or absence of palpable spasm of the paraspinal muscles was not used as an entry criterion because the clinical significance and reliability of this finding is uncertain.


At the conclusion of the ED visit, the patient was required to have a diagnosis consistent with non-traumatic, non-radicular, musculoskeletal low back pain and was to be discharged home. Patients were also excluded from participation if they would not be available for follow-up, for pregnancy or breast feeding, for a chronic pain syndrome defined as use of any analgesic medication on a daily or near-daily basis, or for allergy, intolerance, or contra-indication to the investigational medications.

Sami Tarnanen: if. J ; Keijo Häkkinen: if. This article has been cited by other articles in PMC.

Flirten singles kostenlos Study participants were randomized in a ratio to orphenadrine, methocarbamol, or placebo. Patients randomized to placebo were randomly assigned to two different sets of dosing instructions to match the different dosing regimens of the active arms--half of the participants were instructed to take the investigational capsule twice per day while the other half were instructed to take it as one or two capsules three times per day.

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We graz leute kennenlernen a flexible dosing plan in the methocarbamol arm in an effort to maximize effectiveness while single side lower back pain side effects. In this study arm, patients were instructed single side lower back pain take one or two pills of the methocarbamol every 8 hours.

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If one tablet of the methocarbamol afforded sufficient relief, there was no need for the patient to take the second tablet. However, if the patient had not experienced sufficient relief within 30 minutes of taking one investigational medication tablet, they were instructed to take the second tablet.

We chose this method of administration because optimal dosing of methocarbamol has not been established. We believe the dosing regimen we chose was sufficient to determine effectiveness while not exposing patients to unnecessary risk.

All study patients were given 14 naproxen tablets, a seven day supply, and a sufficient number of investigational tablets to last 7 days. Each block of six contained two orphenadrine assignments, two methocarbamol assignments, one placebo assignment dosed as one capsule twice daily to mirror orphenadrine dosingand one placebo assignment dosed as 1—2 capsules three times daily to mirror methocarbamol dosing.

Therefore, although patients did not know whether they had been assigned to active medication or placebo, they may have deduced to which medication they were not assigned.

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This did not threaten the internal validity of the study because patients did not know if they received active medication or placebo. Naproxen was not masked. Orphenadrine, methocarbamol, and placebo were masked by placing tablets into identical capsules, which were packed with scant amounts of lactose and sealed.

This masking occurred in a secure location inaccessible to ED personnel. Study participants were presented with two bottles of medication.

The first bottle, containing the naproxen, was labeled in a typical manner. The second bottle, containing orphenadrine, methocarbamol, or placebo, was labeled as investigational medication. Patients were instructed to use the second bottle of investigational medication only as needed for moderate or severe low back pain.

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Research personnel provided each patient with a minute educational intervention. The RMDQ is a item low back pain functional scale recommended for use in low back pain research. Higher scores signify greater low back-related functional impairment.

Ordinal pain scale. Study participants described their back pain using the descriptors severe, moderate, mild, or none.

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Though not validated, this measure has been used frequently in ED-based low back pain studies. Study participants were asked to describe the frequency of their low back pain using the descriptors always, usually, sometimes, rarely, or not at all. Low back pain symptomatology is quite variable.

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Some patients experience no pain unless they move a certain way. Others experience a constant low level of pain. Satisfaction, as measured by response to this question: The next time you go to the ER with low back pain, do you want to receive the same combination of medications?

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