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The Thai Journal of Pharmaceutical Sciences

Abstract

Low back pain (LBP) represents a leading cause of non-fatal disability globally. Its high prevalence and disabling nature highlight the urgent need for effective management strategies. The exact cause of LBP still remains unclear, and thus, its treatment remains symptomatic. LBP is commonly treated with non-steroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants (SMRs). These agents are frequently used in combination to target both inflammation and muscle spasms. However, the clinical guidelines vary widely on the recommendation for the use of such combination therapy. The present review evaluates evidence from randomized clinical trials and systematic reviews on the concurrent use of NSAIDs and SMRs in non-specific LBP. Although some studies report short-term benefits in pain relief and functional outcomes, other studies, especially those using real-world, non-standardized regimens, show no added advantage over monotherapy. Overall, the evidence supporting the efficacy of combination therapy remains inconclusive and provides limited support for the regular use of the same. Lack of consistent methodology, particularly the use of non-standardized dosing regimens and outcome measures, is a major limitation of these studies. Thus, the applicability of their findings to the wider population becomes difficult. Future research should focus on standardized study protocols, long-term safety data, and identifying patient subgroups that could benefit most. By summarizing current data, this review aims to clarify the clinical role of NSAID-SMR combinations and outline priorities for future research.

DOI

10.56808/3027-7922.2997

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