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Benzodiazepines have 'little benefit for lower back pain'

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Benzodiazepines do not to appear to significantly improve lower back pain for patients presenting in accident and emergency, according to US researchers.

They found emergency patients treated with the non-steroidal anti-inflammatory drug naproxen and placebo for acute lower back pain had outcomes as good as or better than others given both naproxen and the benzodiazepine diazepam (Valium).

“If anything, we may be overmedicating these patients”

Benjamin Friedman

In their study published in the Annals of Emergency Medicine, researchers randomised 114 A&E patients with new-onset lower back pain to receive either treatment combination.

One week after visiting the emergency department, the diazepam group improved by 11 points on the Roland Morris Disability Questionnaire measure of back pain, as did the placebo group.

After one week, 31.5% of the diazepam patients reported moderate or severe lower back pain, while 21.8% of the placebo patients did.

At three months, 12% of diazepam patients reported moderate or severe lower back pain, while 9% of placebo patients did. The differences were not considered clinically or statistically significant.

Lead study author Dr Benjamin Friedman, from the Albert Einstein College of Medicine in New York, highlighted there was currently no “silver bullet in pill form” to help patients seeking relief from debilitating back pain.

“By three months after visiting the emergency department, most patients had recovered completely, regardless of what treatment they received,” he said.

“Our study contributes to the growing body of literature indicating that, in general, most medications do not improve acute lower back pain,” he said.

Dr Friedman added: “If anything, we may be overmedicating these patients.”

“Unfortunately, we have yet to come up with the silver bullet in pill form that helps them”

Benjamin Friedman

Meanwhile, a second newly published study has suggested personalised physical therapy brings relief for lower back pain.

It concluded that a combination of manual therapy and exercise was an excellent way to combat movement control impairment, where incorrect back position was provoking lower back pain.

The combination reduced the disability experienced by patients and significantly improved their functional ability, said the researchers from the University of Eastern Finland.

In addition, they found that a personally tailored exercise programme was more beneficial for patients than a generic one, and the treatment results also persisted at a 12-month follow-up.

A total of 70 patients took part in the study, which was published in the European Journal of Physiotherapy and BMC Musculoskeletal Disorders.

Participants received five physical therapy sessions, including either personally tailored or generic exercises. Each session also included a brief manual therapy.

The study results indicated that a three-month physical therapy period significantly improved the functional ability of both groups, and the results persisted at a 12-month follow-up.

In addition, the results of the group doing personally tailored exercises were statistically and clinically better than the results of the group doing generic exercises both with regard to the level of disability and improvement of functional ability.

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