Low-dose tramadol and non-steroidal anti-inflammatory drug combination therapy prevents the transition to chronic low back pain

Abstract

Study Design: Retrospective study.Purpose: To determine whether low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy could prevent thetransition of acute low back pain to chronic low back pain.Overview of Literature: Inadequately treated early low back pain transitions to chronic low back pain occur in approximately 30%of affected individuals. The administration of non-steroidal anti-inflammatory drugs is effective for treatment of low back pain in theearly stages. However, the treatment of low back pain that is resistant to non-steroidal anti-inflammatory drugs is challenging.Methods: Patients who presented with acute low back pain at our hospital were considered for inclusion in this study. After the diagnosisof acute low back pain, non-steroidal anti-inflammatory drug administration was started. Forty patients with a visual analogscale score of >5 for low back pain 1 month after treatment were finally enrolled. The first 20 patients were included in a non-steroidalanti-inflammatory drug group, and they continued non-steroidal anti-inflammatory drug therapy for 1 month. The next 20 patientswere included in a combination group, and they received low-dose tramadol plus non-steroidal anti-inflammatory drug combinationtherapy for 1 month. The incidence of adverse events and the improvement in the visual analog scale score at 2 months after the startof treatment were analyzed.Results: No adverse events were observed in the non-steroidal anti-inflammatory drug group. In the combination group, administrationwas discontinued in 2 patients (10%) due to adverse events immediately following the start of tramadol administration. At 2months, the improvement in the visual analog scale score was greater in the combination group than in the non-steroidal anti-inflammatorydrug group (p <0.001).Conclusions: Low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy might decrease the incidence ofadverse events and prevent the transition of acute low back pain to chronic low back pain.