Comparison between efficacy of ketorolac, trometamol and naproxen for acute low back pain
Acute low back pain is defined as low back pain that presents for up to six weeks. It may be experienced as aching, burning, stabbing, sharp or dull, well-defined, or vague. The pain intensity ranges from mild to severe and may radiate into one or both buttocks, thigh and hip area. At least 80% of individuals experience a significant episode of low back pain at some point in their lives. The exact source of acute low back pain is often difficult to identify.
In fact, there are numerous possible pain producers including muscles, soft connective tissue, ligaments, joint capsules and cartilage and blood vessels. These tissues may be pulled, strained, stretched or sprained.
Local application of heat or ice can temporarily reduce pain and heat may facilitate stretching, but does not necessarily speed long term recovery. Medications are also available to treat the chronic pain. Both acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are analgesics which are known to provide effective reduction in acute low back pain. Other medications like ketorolac (KT), trometamol, naproxen (NA) etc. are also prescribed. To compare the efficacy of these drugs, a clinical trial was performed.
In the conducted clinical trial of 10 days, participants with acute low back pain of moderate-to-severe intensity were determined through a visual analog scale (VAS) and were randomly assigned in a 1:1 ratio to receive sublingual ketorolac 10 mg for three times daily or oral NA 250mg three times daily. Dosage was increased when needed. A post hoc superiority analysis was also performed after observing reduction in low back pain measured by VAS.
After randomized double-blind, double-dummy, non-inferiority trial, it was observed that Ketorolac was not inferior to NA for the reduction in low back pain over 5 days of use as measured by VAS scores and by the Roland-Morris Disability Questionnaire using 95% confidence intervals. Improvement was seen after the 60 minutes of administration of first dose in patients. The most common adverse effects were heart burn, nausea and vomiting.
Results of the conducted study after comparison KT with the gold standard NSAID NA indicated that KT was a beneficial option for the treatment of low back pain. It was stated that KT was not inferior to NA in efficacy, also provided faster pain relief and proven to be a safe acute treatment option for acute pain relief.