Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore, Bronx, NY.
Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore, Bronx, NY.
Ann Emerg Med. 2019 Oct;74(4):512-520. doi: 10.1016/j.annemergmed.2019.02.017. Epub 2019 Apr 5.
Patients with low back pain are often treated with nonsteroidal anti-inflammatory drugs and skeletal muscle relaxants. We compare functional outcomes and pain among patients with acute low back pain who were randomized to a 1-week course of ibuprofen plus placebo versus ibuprofen plus 1 of 3 skeletal muscle relaxants: baclofen, metaxalone, and tizanidine.
This was a randomized, double-blind, parallel-group, 4-arm study conducted in 2 urban emergency departments (EDs). Patients with nonradicular low back pain for less than or equal to 2 weeks were eligible if they had a score greater than 5 on the Roland-Morris Disability Questionnaire, a 24-item inventory of functional impairment caused by low back pain. All participants received 21 tablets of ibuprofen 600 mg, to be taken 3 times a day as needed. Additionally, they were randomized to baclofen 10 mg, metaxalone 400 mg, tizanidine 2 mg, or placebo. Participants were instructed to take 1 or 2 of these capsules 3 times a day as needed. All participants received a 10-minute educational session. The primary outcome was improvement on the Roland-Morris Disability Questionnaire between ED discharge and 1week later. Secondary outcomes included pain intensity 1 week after ED discharge (severe, moderate, mild, or none).
Three hundred twenty patients were randomized. One week later, the mean Roland-Morris Disability Questionnaire score of patients randomized to placebo improved by 11.1 points (95% confidence interval [CI] 9.0 to 13.3), baclofen by 10.6 points (95% CI 8.6 to 12.7), metaxalone by 10.1 points (95% CI 8.0 to 12.3), and tizanidine by 11.2 points (95% CI 9.2 to 13.2). At 1-week follow-up, 30% of placebo patients (95% CI 21% to 41%) reported moderate to severe low back pain versus 33% of baclofen patients (95% CI 24% to 44%), 37% of metaxalone patients (95% CI 27% to 48%), and 33% of tizanidine patients (95% CI 23% to 44%).
Adding baclofen, metaxalone, or tizanidine to ibuprofen does not appear to improve functioning or pain any more than placebo plus ibuprofen by 1 week after an ED visit for acute low back pain.
对于腰痛患者，常采用非甾体抗炎药和骨骼肌松弛剂进行治疗。我们比较了随机接受为期 1 周治疗的急性腰痛患者的功能结局和疼痛，这些患者分别接受布洛芬加安慰剂与布洛芬加 3 种骨骼肌松弛剂中的 1 种联合治疗：巴氯芬、美沙酮和替扎尼定。
这是一项在 2 家城市急诊部（ED）进行的随机、双盲、平行分组 4 臂研究。如果患者的 Roland-Morris 残疾问卷评分大于 5（24 项与腰痛相关的功能障碍评估问卷），且腰痛持续时间少于或等于 2 周，则认为其患有非神经根性腰痛，符合纳入标准。所有参与者均接受 21 片布洛芬 600mg，按需每日 3 次服用。此外，他们被随机分为巴氯芬 10mg、美沙酮 400mg、替扎尼定 2mg 或安慰剂组。指导参与者按需每日服用 1 或 2 粒这些胶囊。所有参与者均接受了 10 分钟的教育课程。主要结局是 ED 出院后 1 周时 Roland-Morris 残疾问卷的改善情况。次要结局包括 ED 出院后 1 周时的疼痛强度（严重、中度、轻度或无）。
共 320 名患者被随机分组。1 周后，接受安慰剂治疗的患者的 Roland-Morris 残疾问卷评分平均改善 11.1 分（95%置信区间 [CI] 9.0 至 13.3），巴氯芬组改善 10.6 分（95%CI 8.6 至 12.7），美沙酮组改善 10.1 分（95%CI 8.0 至 12.3），替扎尼定组改善 11.2 分（95%CI 9.2 至 13.2）。在 1 周随访时，30%的安慰剂组患者（95%CI 21%至 41%）报告腰痛为中度至重度，而巴氯芬组为 33%（95%CI 24%至 44%），美沙酮组为 37%（95%CI 27%至 48%），替扎尼定组为 33%（95%CI 23%至 44%）。
在 ED 就诊治疗急性腰痛后 1 周，与布洛芬加安慰剂相比，加用巴氯芬、美沙酮或替扎尼定似乎并不能改善功能或疼痛。
