Diazepam Adds Nothing to Naproxen Therapy for Low Back Pain

Summary and Comment |
February 23, 2017

Diazepam Adds Nothing to Naproxen Therapy for Low Back Pain

  1. Daniel J. Pallin, MD, MPH

A high-quality, moderate-sized, randomized, placebo-controlled trial shows no benefit from diazepam in patients with acute nontraumatic nonradicular low back pain.

  1. Daniel J. Pallin, MD, MPH

Benzodiazepines are centrally acting sedatives and are commonly, although inaccurately, considered to be “muscle relaxants” when prescribed for low back pain. Investigators at two urban academic emergency departments randomized 114 patients with acute nontraumatic nonradicular low back pain to receive naproxen 500 mg twice daily as needed for pain along with either placebo or diazepam 5 mg twice daily as needed.

At 1-week follow-up, improvements in pain and disability were similar in the two groups: 32% of diazepam patients and 22% of placebo patients reported moderate or severe low back pain, and scores on the Roland-Morris Disability Questionnaire improved by 11 points in both groups. Adverse events were mild and comparable in the two groups.

Comment

A prior study by the same investigators provided good evidence that opioids and cyclobenzaprine are not beneficial in the treatment of nontraumatic nonradicular low back pain (NEJM JW Emerg Med Dec 2015 and JAMA 2015; 314:1572).We should treat low back pain with nonsteroidal anti-inflammatory medications, acetaminophen, or a combination, and specifically not opioids or benzodiazepines, and certainly not muscle relaxants.

Editor Disclosures at Time of Publication

  • Disclosures for Daniel J. Pallin, MD, MPH at time of publication Grant / Research support NIH–National Center for Advancing Translational Sciences Leadership positions in professional societies Society for Academic Emergency Medicine (Co-Chair, Scientific Subcommittee of Program Committee, 2015–2016; Chair, Program Committee, 2017–2018)

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