Search
NSAIDs for lower back pain (LBP)
NSAIDs are recommended for first line treatment of lower back pain.
Ibuprofen (600mg), ketorolac (10mg) and diclofenac (50mg) were compared.
3 arm, double-blinded study in an ED population with musculoskeletal LBP.
66 patients in each arm.
Outcomes via telephone interview 5 days later
Primary outcome was improvement in Roland-Morris Disability Questionnaire (RMDQ).
Lower scores indicate better LBP functional outcomes.
Secondary outcomes: Pain intensity and the presence of stomach irritation.
Baseline characteristics similar in 3 groups.
Results: No significant differences between 3 arms in primary outcome.
Ibuprofen 9.4, ketorolac 11.9, and diclofenac 10.9 (p = 0.34).
Ketorolac group reported less overall pain intensity at day 5.
Ketorolac group reported less stomach irritation that the other drugs ((p < 0.01).
While there was no differences in terms of functional outcomes, there may be a benefit of using ketorolac in terms of overall pain intensity and stomach irritation. This would benefit from further study in a larger population in order to draw definitive conclusions.
References
Irizarry E, Restivo A, Salama M, Davitt M, Feliciano C, Cortijo-Brown A, Friedman BW. A randomized controlled trial of ibuprofen versus ketorolac versus diclofenac for acute, nonradicular low back pain. Acad Emerg Med. 2021 Jun 16. doi: 10.1111/acem.14321. Epub ahead of print. PMID: 34133820.