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Acetaminophen, celecoxib, loxoprofen, and tramadol+acetaminophen show comparable efficacy for chronic low back pain, with no clear superiority across pain, disability, or quality-of-life outcomes.
A large Japanese nationwide prospective study involving 471 patients with chronic low back pain (CLBP) reported comparable effectiveness among four commonly prescribed analgesics, highlighting the importance of individualized pain management strategies.
In this 6-month multicenter study, adults diagnosed with CLBP received one of four pharmacological treatments: acetaminophen, celecoxib (a cyclooxygenase-2 [COX-2] inhibitor), loxoprofen (nonsteroidal anti-inflammatory drug; NSAID), or tramadol + acetaminophen. Clinical outcomes were assessed monthly using validated measures including:
Multivariable linear regression analyses were performed at 1 month and 6 months after treatment initiation. Statistical significance was defined as P < 0.05. Acetaminophen illustrated remarkable improvement in the mental health subscale of the JOABPEQ at 1 month and in the JOA score at 6 months. However, no other prominent differences were noted between the four drug groups across pain severity, disability, or quality-of-life measures.
Across all treatment groups, most outcome measures improved from baseline, indicating successful symptom relief. However, there was no clear cumulative improvement over the 6-month period. Notably, the mental component summary score of the SF-8 gradually declined in all groups, suggesting that psychological well-being may not improve alongside physical symptoms in chronic low back pain patients.
The findings highlight that acetaminophen, celecoxib, loxoprofen, and tramadol + acetaminophen yield broadly similar clinical benefits in CLBP. No single medication clearly outperforms the others in minimizing pain or disability over 6 months. The results support a personalized, patient-centered approach to CLBP care rather than a one-drug-fits-all strategy.
Spine Surgery and Related Research (SSRR)
Comparison of the Effectiveness of Pharmacological Treatments for Patients with Chronic Low Back Pain: A Nationwide, Multicenter Study in Japan
Gen Inoue et al.
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