The study compared the use of prescription-strength naproxen (Naprosyn) alone to the use of naproxen with the narcotic painkiller oxycodone with acetaminophen (Percocet), or the muscle relaxant cyclobenzaprine (Amrix). Patients who took a combination of drugs fared no better than when they took naproxen alone, the researchers said.
"Acute low back pain is a frustrating condition," said lead researcher Dr. Benjamin Friedman, an associate professor of emergency medicine at Montefiore Medical Center and Albert Einstein College of Medicine in New York City.
Many patients have already taken over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve) or ibuprofen (Advil, Motrin), before they arrive in the emergency room, he said. Some people may have taken insufficient doses at incorrect intervals and could be advised to optimize their NSAID regimen, he said.
"But for those patients who have already optimized their NSAID regimen, there are no additional medical therapies available," Friedman said.
"We don't have good medical treatment for acute low back pain," he added.
The report was published Oct. 20 in the Journal of the American Medical Association.
For the study, Friedman and colleagues randomly assigned just over 300 patients who came to an emergency room complaining of lower back pain to 10 days of treatment with one of three combinations. The combinations included 500 milligrams (mg) of naproxen plus a placebo pill; 500 mg of naproxen plus 5 mg of cyclobenzaprine; or 500 mg naproxen plus a pill containing 5 mg oxycodone and 325 mg acetaminophen.
All of the study participants were given a 10-minute education session on low back pain before leaving the hospital, the study authors noted.
Adding the narcotics or muscle relaxants to naproxen therapy didn't help pain or function any more than naproxen alone, Friedman said. "Nearly 50 percent of patients were still suffering one week later. Nearly 25 percent of the patients were still suffering three months later," he said.
But regardless of the treatment, nearly two-thirds of patients had significantly less pain and better movement one week after starting treatment, the investigators found.
Dr. Houman Danesh, director of integrative pain management in the department of anesthesiology-pain at Mount Sinai School of Medicine in New York City, said, "This is another study to add to the pile that says narcotics are not appropriate to treat back pain."
Although fewer doctors are prescribing narcotic painkillers for back pain, many still do, he said.
"We know that narcotics lower testosterone levels in both men and women," Danesh said. For men, replacing testosterone with supplements can increase the risk of heart attack and death.
"In women, you have no idea of where or how to replace testosterone, so you are changing their biochemistry, which can make them more sensitive to pain," he said.
"Most back pain gets better on its own without anything," Danesh said.
Friedman agreed. "Don't despair -- passage of time will cure most low back pain," he said.
"Some type of complementary therapy such as stretching, yoga, or massage may be more appropriate for many patients," Friedman said. "The solution to lower back pain is not potent medication."