Study: Valium No Better Than Placebo for Lower Back Pain in the ED

“Magic bullet” remains elusive

Emergency patients treated with naproxen and placebo had outcomes as good as or better than patients treated with naproxen and diazepam (Valium, Roche) for acute lower back pain, according to the results of a double-blind, randomized clinical study published in the Annals of Emergency Medicine.

“Our study contributes to the growing body of literature indicating that, in general, most medications do not improve acute lower back pain,” said lead author Benjamin Friedman, MD, MS, of the Albert Einstein College of Medicine/Montefiore Health System in Bronx, New York. “One week after being discharged from the emergency department [ED], lower back pain patients had improved equally, regardless of whether they were treated with naproxen and diazepam or naproxen and placebo. By three months after visiting the emergency department, most patients had recovered completely, regardless of what treatment they received.”

Researchers randomly assigned 114 patients who came to the ED with new-onset lower back pain to two treatment groups. One group was treated with a combination of the nonsteroidal anti-inflammatory drug naproxen and diazepam (a benzodiazepine derivative), and the other group was treated with a combination of naproxen and placebo. One week after visiting the ED, the diazepam group improved by 11 points on the Roland Morris Disability Questionnaire, as did the placebo group.

After one week, 31.5% of the diazepam-treated patients reported moderate or severe lower back pain, whereas 21.8% of the placebo-treated patients did. At three months, 12% of the diazepam group reported moderate or severe lower back pain, whereas 9% of the placebo group did. The differences were not considered clinically or statistically significant.

“Millions of patients come to the [emergency department] every year seeking relief for back pain, which can be debilitating,” Friedman said. “Unfortunately, we have yet to come up with the silver bullet in pill form that helps them. If anything, we may be overmedicating these patients.”

Source: American College of Emergency Physicians; February 16, 2017.