Add-on diclofenac better than monotherapy for managing acute lower back pain

Using diclofenac in combination with TPC (thiamine, pyridoxine and cyanocobalamin) offers superior analgesic effect than diclofenac monotherapy in the management of acute lower back pain (LBP), according to a systematic review and meta-analysis.

Researchers searched multiple online databases for studies evaluating the efficacy of diclofenac used with TPC vs alone (control) for pain management in patients with acute or chronic LBP (primary or secondary; of mild, moderate or severe intensity; and nociceptive, neuropathic or nociplastic in nature). They evaluated the risk of bias regarding randomization, allocation concealment, blinding, incomplete outcome data, selective reporting and other biases.

The search yielded five studies involving 1,108 adult patients in total. Four of these studies used the primary outcome of premature discontinuation of treatment due to complete relief of pain. The quality of evidence was rated as moderate-to-high.

Pooled data showed that more patients who received the combination therapy vs diclofenac monotherapy achieved the primary outcome (189 of 548 vs 128 of 560 patients; risk difference, 12 percent, 95 percent CI, 4–20; p=0.003; relative risk, 1.52, 1.19–1.93; p=0.0007).

Patients who received diclofenac plus TPC were 87 percent as likely as those treated with diclofenac monotherapy to achieve pain relief (odds ratio, 1.87, 1.28–2.72; p=0.001; number needed to treat to benefit, 9, 6–16).

The researchers noted the need for more studies to confirm the safety of diclofenac plus TPC, as well as to examine TPC as a new analgesic adjuvant therapy in several types of pain such as mixed pain syndromes, osteoarthritis, postoperative pain and cancer, among others.