 |
|
Cyclobenzaprine and Back Pain
A Meta-analysis
Robert Browning, MD;
Jeffrey L. Jackson, MD, MPH;
Patrick G. O'Malley, MD, MPH
Arch Intern Med. 2001;161:1613-1620.
Background Back pain is a common problem for which cyclobenzaprine hydrochloride
is frequently prescribed.
Objective To perform a systematic review of cyclobenzaprine's effectiveness in
the treatment of back pain.
Methods We searched MEDLINE, PsycLIT, CINAHL, EMBASE, AIDSLINE, HEALTHSTAR,
CANCERLIT, the Cochrane Library, Micromedex, Federal Research in Progress,
and the references of reviewed articles, and contacted Merck, Sharpe and Dohme
for English-language, randomized, placebo-controlled trials of cyclobenzaprine
in adults with back pain. Outcomes included global improvement and 5 specific
domains of back pain (local pain, muscle spasm, range of motion, tenderness
to palpation, and activities of daily living). Study quality was assessed
using the methods of Jadad. Summary outcomes were obtained using a random-effects
model.
Results Patients treated with cyclobenzaprine were nearly 5 times (odds ratio,
4.7; 95% confidence interval, 2.7-8.1) as likely to report symptom improvement
by day 14 as were those treated with placebo. Slightly fewer than 3 individuals
(2.7; 95% confidence interval, 2.0-4.2) needed treatment for 1 to improve.
The magnitude of this improvement was modest, with an effect size of 0.38
to 0.58 in all 5 outcomes (local pain, muscle spasm, tenderness to palpation,
range of motion, and activities of daily living). Treatment efficacy for these
5 outcomes was greatest early, in the first few days of treatment, declining
after the first week. Patients receiving cyclobenzaprine also experienced
more adverse effects, the most common being drowsiness.
Conclusions Cyclobenzaprine is more effective than placebo in the management of
back pain; the effect is modest and comes at the price of greater adverse
effects. The effect is greatest in the first 4 days of treatment, suggesting
that shorter courses may be better. Studies comparing the relative value of
acetaminophen, nonsteroidal anti-inflammatory drugs, and cyclobenzaprine individually
and in combination in the treatment of back pain are needed.
From the Departments of Medicine, National Naval Medical Center (Dr
Browning), and Uniformed Services University of the Health Sciences (Drs Jackson
and O'Malley), Bethesda, Md; and the Department of Medicine, Walter Reed Army
Medical Center, Washington, DC (Drs Jackson and O'Malley).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Medications for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline
Chou and Huffman
ANN INTERN MED 2007;147:505-514.
ABSTRACT
| FULL TEXT
Nonsurgical Management of Acute and Chronic Low Back Pain
Shen et al.
J Am Acad Orthop Surg 2006;14:477-487.
ABSTRACT
| FULL TEXT
Evaluation and Treatment of Posterior Neck Pain in Family Practice
Douglass and Bope
J Am Board Fam Med 2004;17:S13-S22.
ABSTRACT
| FULL TEXT
Evaluation and Treatment of Low Back Pain in Family Practice
Rives and Douglass
J Am Board Fam Med 2004;17:S23-S31.
ABSTRACT
| FULL TEXT
The Effect of Antidepressant Treatment on Chronic Back Pain: A Meta-analysis
Salerno et al.
Arch Intern Med 2002;162:19-24.
ABSTRACT
| FULL TEXT
Cyclobenzaprine Better Than Nothing for Acute Back Pain
JWatch Emergency Med. 2001;2001:8-8.
FULL TEXT
Cyclobenzaprine Helps Back Pain -- Somewhat
JWatch General 2001;2001:6-6.
FULL TEXT
|
