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Most people who go to the doctor with acute back pain are advised to keep moving and take regular paracetamol. Adding diclofenac, spinal manipulation (physiotherapy), or both to this recommended first line strategy doesn't help them recover any faster, according to a randomised trial from AustraliaAustralia.
The 240 participants had their first pain free day in a median of about two weeks whether they had spinal manipulation alone, diclofenac alone, both extra treatments, or neither extra treatment. Time to more sustained recovery was also comparable among the groups. Neither of the extra treatments had any effect on pain intensity or disability. The trial was carefully done, double blind, and fully controlled with placebo manipulation (detuned pulsed ultrasound) and placebo diclofenac. All treatments lasted up to four weeks and compliance was moderate to good.
General practitioners can now confidently reassure patients with uncomplicated acute back pain that they will probably recover within a few weeks if they avoid staying in bed, move around as much as possible, and take 1 g of paracetamol every four hours or so, say the authors. There is no need for the extra expense and risks of additional non-steroidal anti-inflammatory drugs or physiotherapy. A linked commentary says the same (p 1595).