The following is a summary of “Multimodal Analgesia Approach in Acute Low Back Pain Management: A Phase III Study of a Novel Analgesic Combination of Etoricoxib/Tramadol,” published in the September 2024 issue of Pain by Zuqui-Ramírez et al.

Adequate pain and disability management is vital for speedy recovery, and combining analgesics with different mechanisms of action can improve pain relief while reducing doses and supporting efficient multimodal analgesia.

Researchers conducted a retrospective study to compare the efficacy and safety of 2 fixed-dose combinations—etoricoxib/tramadol vs. paracetamol/tramadol—for managing acute low back pain over a 7-day treatment course.

They examined patients with acute low back pain and compared etoricoxib 90 mg/tramadol 50 mg (one packet of granules diluted in 100 ml of water, once a day [QD], for 7 days) with paracetamol 975 mg/tramadol 112.5 mg (one tablet of 325 mg/37.5 mg, 3 times a day [TID], for 7 days) to assess efficacy (pain and disability improvement) and safety.

The results showed 124 patients who were categorized to receive either etoricoxib/tramadol QD (n=61) or paracetamol/tramadol TID (n=63) observed differences in pain reduction at day 3  (P=0.054, CI 95% −0.648 [−0.010 to 1.306]) and day 5 (P=0.041). A notable ratio of 30% observed a decrease in Visual Analogue Scale (VAS) scores by the 3rd day (P=0.008, CI 95% 0.241 [0.061–0.421]). Both treatment groups enhanced disability-related daily activities (Oswestry and Roland–Morris questionnaires). A total of 79 adverse events (AEs) were reported, with 38 (48.1%) in the etoricoxib/tramadol group and 41 (51.9%) in the paracetamol/tramadol, where nausea (17.7%) and dizziness (16.4%) were common. 

They concluded etoricoxib/tramadol FDC exhibited clinical benefits over paracetamol/tramadol, including reduced daily tramadol dosage, faster pain relief, improved adherence, lower tramadol dependency, and fewer associated AEs.

Source: link.springer.com/article/10.1007/s40122-024-00653-y