According to a recently published study, there was no significant difference in results between ibuprofen, ketorolac and diclofenac as first-line treatments for non-radicular low back pain. Academic Emergency Medicine.
This double-blind, three-arm comparative effectiveness study included 198 participants who were admitted to the emergency department for musculoskeletal low back pain. These participants were randomly assigned to receive 600 mg of ibuprofen (n=66), 10 mg of ketorolac (n=66), or 50 mg of diclofenac (n=66), taking every 8 hours as needed.
The main result is the change in Roland-Morris Disability Questionnaire (RMDQ) scores between days 0 and 5 determined by telephone interviews on the 2nd and 5th days after admission (the lower the score, the better the result of low back pain) . As a secondary result, the researchers assessed gastric irritation and pain intensity (none, mild, moderate, severe).
The main result difference was analyzed using one-way analysis of variance.
Among the 198 registered participants, the RMDQ improvement on day 5 was as follows: ibuprofen (9.4±9.5 points), ketorolac (11.9±8.8 points), and diclofenac (10.9±9.4 points) (overall analysis of variance) phosphorus =.34). 28% (n=17) of the ibuprofen group, 46% (n=27) of the ketorolac group, and 40% (n=25) of the diclofenac group had mild pain on day 5, but no pain, respectively 33% (n=20), 34% (n=20) and 32% (n=20).
This resulted in an 18% (95% CI, 2-34) difference between ibuprofen and ketorolac (phosphorus =.04). 26% of patients taking ibuprofen (n=16), 5% of patients taking ketorolac (n=3), and 9% of patients taking diclofenac (n=6) reported gastric irritation.phosphorus <.01).
The limitations of this study include the study area with high socioeconomic depression (hence the uncertain generality), the 600 mg ibuprofen dose may increase side effects, the lack of evaluation of the baseline pain score, the lack of analgesic use records, and facts On the other hand, the study’s effectiveness on some results is insufficient.
The researchers concluded that “in terms of the main results, there were no important differences between the groups.” However, they noted, “[these] Data does not exclude [the] Ketorolac may relieve pain and reduce stomach irritation better than ibuprofen. “
Irizarry E, Restivo A, Salama M, etc.Randomized controlled trial of ibuprofen, ketorolac and diclofenac in the treatment of acute non-radicular low back pain [published online June 16, 2021]. Acad Emerg Med. doi:10.1111/acem.14321