Naproxen With Cyclobenzaprine, Oxycodone Acetaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial Pain Medicine JAMA

They were randomized to receive either 60 tablets of placebo; cyclobenzaprine, 5 mg; or oxycodone, 5 mg/acetaminophen, 325 mg. Participants were instructed to take 1 or 2 of these tablets every 8 hours, as needed for LBP. They also received a standardized 10-minute LBP educational session prior to discharge. Cyclobenzaprine is a centrally acting skeletal-muscle relaxant, claimed to be effective in providing relief of muscle spasm, pain and tenderness, and in reducing the limitations imposed thereby on normal daily activities.

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Additional outcomes assessed at seven days included severity of pain, frequency of medication use during the preceding 24 hours, patient satisfaction, length of time to return to normal activities, frequency of visits to any clinician, and adverse events. Patients were also contacted at three months after the ED visit to assess the change in their RMDQ. Objective To compare functional outcomes and pain at 1 week and 3 months after an ED visit for acute LBP among patients randomized to a 10-day course of (1) naproxen + placebo; (2) naproxen + cyclobenzaprine; or (3) naproxen + oxycodone/acetaminophen. Drug interactions may change how your medications work or increase your risk for serious side effects.

Pain control is essential to ensure patient comfort, to promote pulmonary toilet, and to aid physical therapy regimens. Many analgesics have sedating properties that benefit patients who have sustained injuries. Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication.

Drug Interactions between Flexeril and naproxen

In this study, we saw no difference in outcomes between those randomized to receive naproxen + placebo vs those randomized to receive naproxen + oxycodone/acetaminophen. However, among patients who used the investigational medication more than once, fewer patients who used oxycodone/acetaminophen reported moderate or severe pain. These latter findings must be interpreted cautiously because of the large number of analyses we performed. Quiz Ref IDPatients were excluded for radicular pain, which we defined as pain radiating below the gluteal folds, direct trauma to the back within the previous month, pain duration for more than 2 weeks, or recent history of greater than 1 LBP episode per month.

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If you notice other effects not listed above, contact your doctor or pharmacist. Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Drowsiness, dizziness, dry mouth, constipation, or tiredness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. Painosoma.com is an information-providing website and does not sell any products. We are not advising our users to take any drugs discussed on our website. If the user does so, painosoma.com will not be liable for damages.

Naproxen is eliminated in half by hours, it takes about 3 and half days to push it out of the system.It can also increase the time further if the user is undergoing gastric or stomach related problems. The 2nd round of differentiation can be in terms of its elimination flexeril muscle relaxer side effects time.The elimination of medicines depends upon the absorption rate, metabolism , conditions and other medicines etc. The medicine world is not too unleft from this, many types of medicine in many formats and types, but which is the most effective?.

What are the side effects of cyclobenzaprine and naproxen?

However, for patients who have already optimized their NSAID regimen, there are no additional evidence-based medical therapies available. Quiz Ref IDOur results show that that adding cyclobenzaprine or oxycodone/acetaminophen to naproxen does not improve pain at 7-day or 3-month follow-up. It is also true that corticosteroids20 and acetaminophen21 are not beneficial for patients with nonradicular LBP. We were unable to find high-quality published data that evaluated the efficacy of opioids combined with NSAIDs for acute LBP. Available data do not support the superiority of opioids over NSAIDs.19 In this study, oxycodone/acetaminophen + naproxen was not better than placebo + naproxen. We identified a difference in pain outcomes among participants who took oxycodone/acetaminophen more than once when compared with those who took placebo more than once.

• Cyclobenzaprine (Flexeril) is structurally similar to TCAs and, as such, demonstrates significant anticholinergic side effects.
• Selected from data included with permission and copyrighted by First Databank, Inc.
• However, 40% of the cohort reported moderate or severe pain, half reported functionally impairing LBP, and nearly 60% were still using medication for their LBP 1 week later.

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Presumably the people in this study landed in the ER because of serious back pain, and many were likely already taking NSAIDs. For back pain flare-ups, judicious use of NSAIDs and patience are still the safest and most effective overall strategies for back pain flare-ups. Some mixtures of medications can lead to serious and even fatal consequences. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

It is also unclear whether these patients may have stopped taking the medications early due to sufficient pain relief without recurrence after discharge. With regards to outcomes, the study’s shortest assessment was at seven days. Furthermore, the study only assessed one type of opioid (oxycodone) and one type of muscle relaxant (cyclobenzaprine) given at a frequency of once every eight hours. This may not apply to other opioids or muscle relaxants or different frequencies of use. For example, oxycodone is typically prescribed every four to six hours rather than every eight hours. Taking the medication every six hours may increase pain control at the risk of increased side effects.