A three-arm randomized trial shows no added benefit from orphenadrine or methocarbamol when added to naproxen.
Investigators previously showed that diazepam does not improve outcomes in patients with low back pain treated with naproxen (NEJM JW Emerg Med Apr 2017 and Ann Emerg Med 2017; 70:169). Using a similar randomized, double-blind study design, the investigators assessed the added value of the nonbenzodiazepine “muscle relaxants,” methocarbamol and orphenadrine.
They enrolled 240 patients aged 18 to 69 years with acute, nontraumatic, nonradicular low back pain at two urban emergency departments. All patients were instructed to take naproxen (500 mg twice daily) and were randomized to one of three additional treatments: placebo, methocarbamol (750–1500 mg three times per day), or orphenadrine (100 mg twice per day). At 7 days, there were no clini…
Reviewing Author
DisclosuresConsultant/Advisory BoardPortola Pharmaceuticals, Inc.
Speaker’s BureauPeerView Institute for Medical Education
Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals
DisclosuresConsultant/Advisory BoardPortola Pharmaceuticals, Inc.
Speaker’s BureauPeerView Institute for Medical Education
Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals