Ann Emerg Med

Does topical diclofenac have a role in the management of acute low back pain?

July 9, 2024

Among patients with nontraumatic, nonradicular acute musculoskeletal low back pain discharged from an ED, topical diclofenac was probably less efficacious than oral ibuprofen and showed no additive benefit when coadministered with oral ibuprofen.

• In this randomized, placebo-controlled double-blind study, 198 patients (mean age, 40 years) presenting to the ED with acute lower back pain were randomized at discharge to receive either 400 mg oral ibuprofen + placebo topical gel, 1% diclofenac topical gel + oral placebo, or 400 mg ibuprofen + 1% diclofenac topical gel. Primary outcome was change in Roland Morris Disability Questionnaire (RMDQ) score between ED discharge and 2 days later. At baseline, the median RMDQ score was 18, indicating substantial low back-related functional impairment.
• Two days after the ED visit, the ibuprofen + placebo group had improved by 10.1 (95% confidence interval [CI], 7.5-12.7), the diclofenac gel + placebo group by 6.4 (95% CI, 4.0-8.8), and the ibuprofen + diclofenac gel by 8.7 (95% CI, 6.3-11.1).
• Between-group differences were as follows: ibuprofen vs. diclofenac, 3.7 (95% CI, 0.2-7.2); ibuprofen vs. both medications 1.4 (95% CI, -2.1-4.9); and diclofenac vs. both medications, 2.3 (95% CI, -5.7-1.0). Medication-related adverse events were reported by 5% of ibuprofen patients, 2% of diclofenac patients, and 6% of patients who received both.

Source:

Khankhel N, et al. (2024, June). Ann Emerg Med. Topical Diclofenac Versus Oral Ibuprofen Versus Diclofenac + Ibuprofen for Emergency Department Patients With Acute Low Back Pain: A Randomized Study. https://pubmed.ncbi.nlm.nih.gov/38441515/