Ibuprofen With or Without Acetaminophen for Low Back Pain

Study Overview
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Brief Summary
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This is a randomized clinical trial comparing two interventions for acute low back pain: Ibuprofen + acetaminophen Ibuprofen + placebo Participants will include patients who present to an emergency room for management of low back pain. Medication will be dispensed to participants at the time of emergency room discharge. Data will be collected from participants by telephone for 1 week.

Official Title
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Ibuprofen With or Without Acetaminophen for Acute, Non-radicular Low Back Pain: A Randomized Trial

Conditions
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Low Back Pain

Intervention / Treatment
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* Drug: Acetaminophen
* Drug: Ibuprofen 600 mg
* Behavioral: Educational intervention
* Drug: Placebo oral capsule


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Present to emergency room primary for management of LBP, defined as pain originating between the lower border of the scapulae and the upper gluteal folds. Flank pain, that is pain originating from tissues lateral to the paraspinal muscles, will not be included. Musculoskeletal etiology of low back. Patients with non-musculoskeletal etiologies such as urinary tract infection, ovarian cysts, or influenza like illness will be excluded. The primary clinical diagnosis, at the conclusion of the emergency room visit, must be a diagnosis consistent with non-traumatic, non-radicular, musculoskeletal low back pain. Patient is to be discharged home. Age 18-69 Non-radicular pain. Patients will be excluded if the pain radiates below the gluteal folds in a radicular pattern. Pain duration <2 weeks (336 hours). Prior to the acute attack of LBP, back pain cannot occur more frequently than once per month. Non-traumatic LBP: no substantial and direct trauma to the back within the previous month Functionally impairing back pain: A baseline score of > 5 on the Roland-Morris Disability Questionnaire Exclusion Criteria: Not available for follow-up Pregnant Chronic pain syndrome defined as use of any analgesic medication on a daily or near-daily basis Allergic to or intolerant of investigational medications

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 69 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Acetaminophen<br>Acetaminophen 500-1000mg every 6 hours for 7 days Participants in this arm will also receive ibuprofen 600mg every 6 hours for 7 days and an educational intervention. | Drug: Acetaminophen<br>* Acetaminophen 500-1000mg every 6 hours<br>Drug: Ibuprofen 600 mg<br>* Ibuprofen 600mg every 6 hours<br>Behavioral: Educational intervention<br>* Research personnel will provide each patient with a 15-minute educational intervention. This will be based on NIAMS (National Institute of Arthritis and Musculoskeletal and Skin Diseases) Handout on Health: Back Pain information webpage (available at http://www.niams.nih.gov/Health_Info/Back_Pain/default.asp)<br>|
| Active Comparator: Placebo<br>Placebo Participants in this arm will also receive ibuprofen 600mg every 6 hours for 7 days and an educational intervention. | Drug: Ibuprofen 600 mg<br>* Ibuprofen 600mg every 6 hours<br>Behavioral: Educational intervention<br>* Research personnel will provide each patient with a 15-minute educational intervention. This will be based on NIAMS (National Institute of Arthritis and Musculoskeletal and Skin Diseases) Handout on Health: Back Pain information webpage (available at http://www.niams.nih.gov/Health_Info/Back_Pain/default.asp)<br>Drug: Placebo oral capsule<br>* To match acetaminophen, patients will take one or two capsules every 6 hours<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Functional Impairment as Measured by the Roland Morris Disability Questionnaire | The Roland Morris Disability Questionnaire (RMDQ) is a 24 item instrument that evaluates the impact of low back pain on one's daily life. It is most sensitive for patients with mild to moderate disability due to acute, sub-acute or chronic low back pain. Each question can be answered as either a yes or no. The score ranges from 0 to 24 where a higher score reflects greater impairment and, therefore, worsening in the quality of life. The change in RMDQ is obtained by subtracting the RMDQ score at one week after discharge from the baseline score. The calculated mean and associated confidence interval values have been verified by staff statisticians. | Baseline and one week after discharge from emergency department | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Moderate or Severe Pain, as Measured on an Ordinal Scale | Data collected by telephone questionnaire. Participants asked to assess intensity of low back pain over the previous 24 hours, using a four point ordinal scale: severe, moderate, mild, or none. | 7 days after discharge from emergency department | 
| Number of Participants Who Required Analgesic Medication for Low Back Pain Within the Previous 24 Hours. | Telephone questionnaire is used to assess number of patients needing any analgesic or low back pain medication within the previous 24 hours. | 7 days after discharge from emergency department |