Is Topical Diclofenac Helpful for Patients with Acute Low Back Pain?

Most episodes of acute, nonradicular low back pain will improve, with or without treatment. For patients with low back pain, clinicians often prescribe a combination of oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs; with diclofenac as the typical topical agent). To find out whether this combination is effective, investigators in a single New York emergency department conducted a double-blind randomized trial: 198 patients (mean age, 40) who presented with acute, nonradicular low back pain received a 2-day supply of oral ibuprofen (400 mg, every 6 hours as needed) plus topical placebo gel, topical diclofenac (1% gel) plus oral placebo, or ibuprofen plus diclofenac (combination treatment).

At 2 days, all treatment groups improv…