Before we remove another medication from our already anemic quiver in the treatment of back pain, I think we have to be more realistic of the goals of the community ED doc. The conclusion of the authors may be correct based on the parameters of the study, but I disagree with their primary end point, and its application to the actual practice of what we do everyday in the ED.
The study focuses on a change in functional outcome at 1 week and 3 months. I don’t know a single practitioner who believes that any treatment we render for back pain in the ED is improving their long-term outcome. Let’s be honest, we just want them to feel a little better right now. What I would like to see is a study to evaluate the change in pain shortly after taking diazepam. If all we cared about was functional outcome at 1 week and 3 months, we should stop prescribing pain medication for fractures, kidney stones, and other painful conditions–at least until a study shows improvement of long-term functional outcome by treating the associated pain with those ailments.
By the way, Anand notes in his blog that the study had a low inclusion rate and did not control for unemployment rate. Perhaps a better powered study that controlled for those types of variables, and gave us a more meaningful end-point would convince guys like me to change my practice.
One Response to “Naproxen, Diazepam Evaluated for Treating Acute, Nontraumatic Low Back Pain”
June 30, 2017
jeff wuBefore we remove another medication from our already anemic quiver in the treatment of back pain, I think we have to be more realistic of the goals of the community ED doc. The conclusion of the authors may be correct based on the parameters of the study, but I disagree with their primary end point, and its application to the actual practice of what we do everyday in the ED.
The study focuses on a change in functional outcome at 1 week and 3 months. I don’t know a single practitioner who believes that any treatment we render for back pain in the ED is improving their long-term outcome. Let’s be honest, we just want them to feel a little better right now. What I would like to see is a study to evaluate the change in pain shortly after taking diazepam. If all we cared about was functional outcome at 1 week and 3 months, we should stop prescribing pain medication for fractures, kidney stones, and other painful conditions–at least until a study shows improvement of long-term functional outcome by treating the associated pain with those ailments.
By the way, Anand notes in his blog that the study had a low inclusion rate and did not control for unemployment rate. Perhaps a better powered study that controlled for those types of variables, and gave us a more meaningful end-point would convince guys like me to change my practice.