Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-27T12:22:54.390Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial

Published online by Cambridge University Press:  21 May 2015

S. Mustafah Khwaja ,
Max Minnerop  and
Adam J. Singer
S. Mustafah Khwaja
Affiliation:
Department of Emergency Medicine, Stony Brook University, Stony Brook, NY
Max Minnerop
Affiliation:
Department of Emergency Medicine, Stony Brook University, Stony Brook, NY
Adam J. Singer*
Affiliation:
Department of Emergency Medicine, Stony Brook University, Stony Brook, NY
*
Department of Emergency Medicine, HSC-L4-080, 8350 SUNY, Stony Brook NY 11794-8350; adam.singer@stonybrook.edu

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

We compared pain severity and time to resumption of activities in patients with cervical strains treated with a nonsteroidal anti-inflammatory drug (NSAID), a centrally acting muscle relaxant or both.

Methods:

We performed a double-blinded, randomized controlled trial of adults with cervical strains from motor vehicle collisions or from falls who presented to a suburban academic emergency department (ED). Patients were randomly assigned to receive ibuprofen 800 mg, cyclobenzaprine 5 mg or both, 3 times daily as needed for up to 7 days. Outcome measures included a pain score on a 100-mm visual analog scale, pain relief scores, the time to resumption of normal activities, the use of rescue medications, and adverse outcomes. We used repeated-measures analysis of variance to compare pain relief over time. Our sample size of 20 patients in each group had a power of 80% to detect a difference of 15 mm in pain relief scores between the highest and lowest groups.

Results:

We randomly assigned 61 patients to receive ibuprofen (n = 20), cyclobenzaprine (n = 21) or both (n = 20). Mean (standard deviation) age was 34 (11) years; 58% were women and 72% were white. Although pain scores improved over time in all groups, there were no significant differences between the groups in any of the outcome measures. The rate of adverse events was also similar between groups.

Conclusion:

Our study suggests that there is little benefit to routinely using or adding cyclobenzaprine to NSAIDs for ED patients with acute cervical strain.

Résumé

RÉSUMÉObjectif:

Nous avons comparé la gravité de la douleur et le temps de reprise des activités chez les patients présentant une entorse du rachis cervical et ayant été traités avec un anti-inflammatoire non stéroïdien (AINS) ou un relaxant musculaire à action centrale, ou les deux.

Méthodes:

Nous avons réalisé un essai contrôlé randomisé à double insu auprès d'adultes qui ont consulté le service d'urgence d'un centre hospitalier universitaire de banlieue pour une entorse du rachis cervical liée à un accident de véhicule automobile ou à une chute. Les participants ont été répartis de façon aléatoire pour recevoir 800 mg d'ibuprofène, 5 mg de cyclobenzaprine, ou les deux, 3 fois par jour, au besoin, pour un maximum de 7 jours. Les principales mesures des résultats comprenaient le score de douleur sur une échelle visuelle analogique de 100 mm, les scores de soulagement de la douleur, le délai de reprise des activités normales, l'utilisation de médicaments de secours et les événements indésirables. Nous avons utilisé une analyse de variance à mesures répétées pour comparer le soulagement de la douleur dans le temps. Chaque groupe de 20 patients était capable à 80 % de détecter une différence de 15 mm quant au score de gravité de la douleur entre le groupe le plus élevé et le groupe le plus bas.

Résultats:

Soixante et un patients ont été répartis de façon aléatoire pour recevoir de l'ibuprofène (n = 20), de la cyclobenzaprine (n = 21) ou les deux (n = 20). L'âge moyen était de 34 ans (écart-type, 11); 58 % étaient des femmes et 72 % étaient Blancs. Bien que les scores de douleur se soient améliorés au fil du temps pour tous les groupes, il n'y avait pas de différences significatives entre les groupes pour aucune des mesures de résultats. Le taux d'événements indésirables était également similaire pour tous les groupes.

Conclusion:

Notre étude indique qu'il y a peu d'avantages à prescrire la cyclobenzaprine ou à l'ajouter de façon routinière aux AINS chez les patients se présentant à l'urgence pour une entorse du rachis cervical.

Keywords

cervical strainibuprofencyclobenzaprine
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 1 , January 2010 , pp. 39 - 44
Copyright
Copyright © Canadian Association of Emergency Physicians 201

References

REFERENCES

1. Dreyer, SJ, Boden, SD. Nonoperative treatment of neck and arm pain. Spine 1998;23:2746–54.10.1097/00007632-199812150-00016Google Scholar
2. Freeman, MD, Croft, AC, Rossignol, AM, et al. A review and methodologic critique of the literature refuting the whiplash syndrome. Spine 1999;24:86–98.10.1097/00007632-199901010-00022Google Scholar
3. Sturzenegger, M, DiStefano, G, Radanov, BP, et al. Presenting symptoms and signs after whiplash injury: the influence of accident mechanisms. Neurology 1994;44:688–93.Google Scholar
4. Cusick, JF, Pintar, FA, Yoganadan, N. Whiplash syndrome: kinematic factors influencing pain patterns. Spine 2001;26:1252–8.10.1097/00007632-200106010-00015Google Scholar
5. Spitzer, WO, Skovron, ML, Salmi, LR, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management. [Erratum, Spine 1995; 20:2372.]. Spine 1995;20(Suppl):1S–73S.Google Scholar
6. Roland, M. A critical review of the evidence for a pain-spasm-pain cycle in spinal disorders. Clin Biomech (Bristol, Avon) 1986;1:102–9.10.1016/0268-0033(86)90085-9Google Scholar
7. Chang, D, Bosco, JA. Cervical spine injuries in the athlete. Bull NYU Hosp Jt Dis 2006;64:119–29.Google Scholar
8. Zmurko, MG, Tannoury, TY, Tannoury, CA, et al. Cervical sprains, disc herniations, minor fractures, and other cervical injuries in the athlete. Clin Sports Med 2003;22:513–21.Google Scholar
9. Browning, R, Jackson, JL, O’Malley, PG. Cyclobenzaprine and back pain. A Meta-analysis. Arch Intern Med 2001;161:1613–20.Google Scholar
10. Basmajian, JV. Cyclobenzaprine hydrochloride effect on skeletal muscle spasm in the lumbar region and neck: two double-blind controlled clinical and laboratory studies. Arch Phys Med Rehabil 1978;59:58–63.Google Scholar
11. Borenstein, DG, Lacks, S, Wiesel, SW. Cyclobenzaprine and naproxen versus naproxen alone in the treatment of acute low back pain and muscle spasm. Clin Ther 1990;12:125–31.Google Scholar
12. Turturro, MA, Frater, CR, D’Amico, FJ. Cyclobenzaprine with ibuprofen versus ibuprofen alone in acute myofascial strain: a randomized, double-blind clinical trial. Ann Emerg Med 2003;41:818–26.10.1067/mem.2003.188Google Scholar
13. Hollander, JE, Singer, AJ. An innovative strategy for conducting clinical research: the Academic Associate Program. Acad Emerg Med 2002;9:134–7.10.1197/aemj.9.2.134Google Scholar
14. Hoffman, JR, Wolfson, AB, Todd, K, et al. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med 1998;32:461–9.Google Scholar
15. Scott, J, Huskisson, EC. Graphic representation of pain. Pain 1976;2:175–84.10.1016/0304-3959(76)90113-5Google Scholar
16. Singer, AJ, Kowalska, A, Thode, HC. Ability of patients to accurately recall the severity of acute painful events. Acad Emerg Med 2001;8:292–5.Google Scholar
17. Hirayama, J, Yamagata, M, Ogata, S, et al. Relationship between low-back pain, muscle spasm and pressure pain thresholds in patients with lumbar disc herniation. Eur Spine J 2006;15:41–7.10.1007/s00586-004-0813-2Google Scholar
18. Bigos, S, Bowyer, O, Braen, G, et al. Acute low back problems in adults. Clinical practice guideline, quick reference guide number 14. Rockville (MD): US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; 1994.Google Scholar