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VBCR - August 2016, Vol 5, No 4 - Back Pain
Wayne Kuznar

Celecoxib is superior to acetaminophen in relieving pain in patients with chronic, nonspecific low back pain, Canadian investigators have found.

Data from a double-blind, randomized, controlled clinical trial revealed greater efficacy with celecoxib on chronic nonspecific low back pain scales and disability index scores compared with acetaminophen.

However, inflammatory lesions of sacroiliac joints and the spine did not change after 28 days of treatment with either drug, according to this new study1 by Mohamed K. Bedaiwi, MD, Rheumatologist, Toronto Western Hospital, Canada, and colleagues.

“Patients treated with celecoxib for 4 weeks showed a greater improvement in pain scores as well as disability, as shown in the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), TBP (total back pain), ODI (Oswestry Disability Index), and NBP(nocturnal back pain), compared with the patients treated with acetaminophen,” explained the investigators.

“In addition to the numerical change, the frequency of patients who had achieved the therapeutic target with ≥50% improvement in NBP and ODI was also greater in the group of patients treated with celecoxib,” they noted.

Fifty patients with low back pain lasting >3 months were consecutively recruited from a specific back pain clinic in a tertiary hospital. To be eligible, they had to have a visual analog pain scale score of ≥4 of 10 in the past week, and nondiagnostic sacroiliac joints on pelvic radiograph. After a washout of existing nonsteroidal anti-inflammatory drugs, patients were randomized to celecoxib 200 mg twice daily or acetaminophen 500 mg twice daily. Mean age of the patients was 41.1 years.

Compared with pretreatment, TBP values at day 28 were significantly decreased in patients treated with acetaminophen (6.3 vs 5.5; P = .04). There was also a significant improvement in Short Form-36 health survey (SF-36) physical component summaries, from 37.8 pretreatment to 40.6 after 4 weeks of acetaminophen therapy (P = .04).

Acetaminophen had no significant effect on ODI, NBP, patient global assessment, or SF-36 mental component summary.

After 4 weeks of treatment with celecoxib, significant reductions in TBP, ODI, NBP, patient global assessment, BASDAI, and Bath Ankylosing Spondylitis Functional Index (BASFI) scores were observed compared with pretreatment (P <.05 for each). TBP scores improved from 6.6 pretreatment to 4.2 after therapy (P <.001), ODI scores improved from 20.4 to 13.6 (P <.001), BASDAI scores improved from 4.7 to 3.2 (P <.001), and BASFI scores reduced from 4.3 to 2.4 (P = .04). In addition, there was a significant improvement in SF-36 physical component summary following celecoxib treatment (P <.05).

The Bath Ankylosing Spondylitis Metrology Index scores and SF-36 mental component summary did not change following 4 weeks of treatment with celecoxib.

Use of celecoxib demonstrated greater decreases than acetaminophen on TBP (–2.0 vs –0.5; P = .04), ODI (–5.0 vs 0.0; P = .008), BASDAI (–1.1 vs –0.4; P = .03), NBP (–1.0 vs 0.0; P = .01), and patient global assessment scores (–2.0 vs 0.0; P = .04).

In addition, more recipients of celecoxib experienced a ≥50% reduction in back pain scales compared with baseline than those who were given acetaminophen. In the celecoxib arm, 34.8% of patients had a ≥50% reduction in ODI compared with only 4.5% in the acetaminophen arm (P = .02). The same trend held true for scores on NBP (41.7% vs 9.1%; P = .02), TBP (33.3% vs 9.1%; P = .07), and BASDAI (30.4% vs 9.1%; P = .13).

The amount of patients with magnetic resonance imaging sacroiliac joints and spine scores of ≥2 did not change following treatment with either drug compared with baseline values.

“Celecoxib treatment demonstrated that 40% of patients reached therapeutic targets on defined outcome measures, whereas acetaminophen achieved the targets in <10%,” stated Dr Bedaiwi and colleagues.

As limitations, the investigators point to the exclusion of patients with inflammatory back pain, and a dosage of acetaminophen that was less than the maximum dosage allowed, whereas celecoxib was tested at full dose.




Reference

  1. Bedaiwi MK, Sari I, Wallis D, et al. Clinical efficacy of celecoxib compared to acetaminophen in chronic nonspecific low back pain: results of a randomized controlled trial. Arthritis Care Res (Hoboken). 2016;68:845-852.
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