salicylates and Back-Pain

A double-blind, 18-center, balanced trial of diflunisal vs. cyclobenzaprine HCl vs. these two drugs combined vs. placebo produced complete results from 175 patients. They had sought treatment at the cooperating centers for acute painful spasms of the back within a day or two of trauma or strain. Global results over the 7 to 10 days of observations revealed a clinically and statistically significant superiority of the combined therapy by Day 4 (P = 0.006) and almost all patients recovered within a week to 10 days. A combination therapy with an effective safe analgesic and a true muscle relaxant for less than a week appears to be an excellent relief measure for acute back problems.

Topics: Acute Disease; Amitriptyline; Back Pain; Diflunisal; Double-Blind Method; Drug Therapy, Combination; Humans; Multicenter Studies as Topic; Muscle Cramp; Muscle Relaxants, Central; Salicylates

Diflunisal and indomethacin were compared in patients with acute lumbago in a double-blind prospective clinical trial. The dosage of diflunisal was 500 mg twice daily (d-group) and the dosage of indomethacin 50 mg three times daily (i-group). Out of 133 patients, 66 were in the d-group and 67 in the i-group. They were followed up for a week. In addition to the patient's own daily evaluation of pain and functional disability, control visits were performed by the investigators on days 0, 3 and 7. Both of the test drugs were effective in the dosages used. Patients' pain was decreased, functional disability was improved and patients' subjective evaluation of treatment efficacy was very similar to that of the investigators. There were no differences as to the treatment efficacy, but reports of side-effects were slightly less (p less than 0.05) in the d-group than in the i-group. If patients who had no side-effects were compared, the efficacy of diflunisal was better than indomethacin (p less than 0.05). It can be said that indomethacin was essentially as effective as diflunisal, but at the expense of an increased frequency of side-effects. In the d-group two patients (3%) and in i-group six patients (9%) discontinued the therapy because of side-effects. In acute lumbago rapid relief of pain and other harmful symptoms hastens improvement. For such indications the choice of drug therapy in general practice should be based in particular on considerations of safety and lack of potential side-effects in addition to efficacy.

Topics: Adolescent; Adult; Aged; Back Pain; Clinical Trials as Topic; Diflunisal; Double-Blind Method; Female; Humans; Indomethacin; Male; Middle Aged; Random Allocation; Salicylates; Time Factors

An open trial with diflunisal (500 mg twice daily) in 766 outpatients consulting their doctor for low back pain, was carried out as part of the project "Back Pain 1981" in Finland. Of the patients (mean age 41 years), 460 had acute lumbago, 144 sciatica and 162 had chronic low back pain as a clinical diagnosis. In each diagnostic group there was a control group of patients receiving no drug therapy. Of the patients 65 percent were men and 35 percent women and the groups did not differ from this distribution in any diagnosis. The efficacy of the treatment was evaluated using four criteria: change of pain at rest and during exercise, patient's evaluation of the efficacy of the treatment, and the need for any supportive treatment. Side-effects of the drug therapy were registered. In all diagnostic groups the relief of pain both at rest and during exercise was greater in patients receiving diflunisal than in the controls. The greatest difference was found in lumbago. The patient's evaluation did not differ between the groups. The drug therapy diminished the need for supportive physical therapy. The frequency of side-effects was 8.6%. They led to the discontinuation of medication in 14 cases (3%). No severe side-effects were found. Diflunisal therapy for the relief of low back pain is therefore considered to be indicated in outpatient care.

Topics: Adolescent; Adult; Aged; Back Pain; Chronic Disease; Clinical Trials as Topic; Diflunisal; Female; Humans; Male; Middle Aged; Salicylates; Sciatica; Sex Factors

Acute soft tissue injuries create pain and limitation of function. Treatment requires analgesia and time for full recovery. Acetaminophen with codeine (650 mg plus 60 mg, respectively, every 4 to 6 hours) is used frequently as the analgesic of choice. Diflunisal (1,000 mg initially then 500 mg twice a day) vs acetaminophen with codeine was prospectively studied in the treatment of acute mild to moderate pain from soft tissue injuries. Thirty-five patients with acute strains, sprains, or low back pain were randomized to treatment (17 acetaminophen with codeine vs 18 diflunisal). Both groups were similar in the amount of pain and type of injury at initiation of therapy. Patient pain rating went from 3.3 +/- 0.6 to 1.6 +/- 1.5 for acetaminophen with codeine and from 3.3 +/- 0.6 to 1.3 +/- 1.1 for diflunisal. However, 65 percent of acetaminophen with codeine patients experienced side effects, with 35 percent of these patients stopping the medication because of intolerable side effects. In the diflunisal group, 28 percent of the patients experienced side effects and 5 percent had to stop the medication early. Diflunisal was found to be an effective analgesic in mild to moderate pain of acute soft tissue injuries, and caused fewer and more tolerable side effects than did acetaminophen with codeine.

Topics: Acetaminophen; Acute Disease; Adult; Back Pain; Clinical Trials as Topic; Codeine; Diflunisal; Drug Combinations; Drug Tolerance; Female; Humans; Male; Pain; Prospective Studies; Random Allocation; Salicylates; Sprains and Strains

Fifty-six patients entered into an open-label, randomized study to compare the efficacy and tolerability of diflunisal and naproxen in the treatment of mild to moderate pain associated with acute low back strain. Thirty-three patients completed the two-week study. No patients withdrew because of side effects, and both drugs were well tolerated. Results showed that diflunisal was more effective than naproxen (81% versus 41%) in relieving pain. Of the 16 patients taking diflunisal, 13 rated its efficacy as very good or excellent; six (35%) of 17 patients taking naproxen rated their drug similarly. Overall, diflunisal rated slightly better in efficacy and tolerability and in improving limitation of function and motion. In addition, diflunisal has a longer duration of action and thus requires less frequent dosing than naproxen.

Topics: Acute Disease; Adult; Back Pain; Clinical Trials as Topic; Diflunisal; Drug Tolerance; Female; Humans; Male; Naproxen; Random Allocation; Salicylates; Sprains and Strains

Effective pain relief and patient tolerance and acceptance are essential in outpatient management of mild to moderate pain of acute low back strain. This study evaluated the efficacy, tolerability, and acceptability of diflunisal and acetaminophen with codeine in patients with mild to moderate pain after an initial or recurrent acute low back strain. Both drugs demonstrated equipotent analgesic efficacy; however, diflunisal was superior to acetaminophen with codeine for patient tolerability and acceptability. The results demonstrated that the study drugs were effective in treating mild to moderate pain caused by acute low back strain in an ambulatory care setting.

Topics: Acetaminophen; Adult; Back Pain; Clinical Trials as Topic; Codeine; Diflunisal; Drug Combinations; Drug Tolerance; Humans; Middle Aged; Random Allocation; Recurrence; Salicylates; Sprains and Strains

One hundred and twelve patients with acute mechanical low back pain were randomly divided into three treatment groups. All patients received ergonomic advice and then either a non-steroidal anti-inflammatory drug or conservative or manipulative types of physiotherapy. Serial assessments of pain and spinal mobility showed similar response rates in all three treatment groups and no significant difference between therapies. The overall improvement ratings, time off work, and economic cost favoured the group treated with the nonsteroidal anti-inflammatory drug, but this group had a better range of spinal flexion at the onset so firm conclusions regarding the preferred management of these patients in general practice cannot be drawn. Treatment failures occurred in all groups highlighting the need for a variety of therapeutic approaches in managing the patient with low back pain.

Topics: Acute Disease; Adolescent; Adult; Back Pain; Clinical Trials as Topic; Diflunisal; Female; Humans; Male; Manipulation, Orthopedic; Middle Aged; Physical Therapy Modalities; Random Allocation; Salicylates

Seventy out-patients with acute back pain participated in a double-blind comparative trial of the clinical efficacy and tolerance of orally administered meptazinol and diflunisal. Half of the patients received 200 mg meptazinol or 250 mg diflunisal 4-times daily for up to 3 weeks, depending on the duration of pain. Patients were examined 4 times at 1-week intervals for their capability to do daily tasks, for their capacity for forward bending, thoraco-lumbar torsion, straight leg raising, static hip flexion and sit-ups, and for subjective assessment of pain. Side-effects were recorded on a questionnaire. Both treatments produced marked improvement in most of the parameters assessed, often within the first week and, overall, the results were similar with the two drugs. Few side-effects were reported and those that were recorded were slight and similar in incidence apart from nausea in 5 meptazinol-treated patients and smarting and burning on urination in 2 patients receiving diflunisal.

Topics: Adult; Azepines; Back Pain; Clinical Trials as Topic; Diflunisal; Double-Blind Method; Female; Humans; Male; Meptazinol; Middle Aged; Salicylates

Topics: Acute Disease; Adolescent; Adult; Back Pain; Chemical Phenomena; Chemistry; Clinical Trials as Topic; Diflunisal; Double-Blind Method; Female; Humans; Male; Middle Aged; Placebos; Salicylates

Topics: Acetaminophen; Adult; Aged; Back Pain; Clinical Trials as Topic; Diflunisal; Double-Blind Method; Humans; Middle Aged; Random Allocation; Salicylates

Thirty-seven patients with chronic back pain were entered into a randomised, 3-way, double-blind, cross-over comparison of naproxen sodium 550 mg twice daily, diflunisal 500 mg twice daily, and placebo. Each treatment was given for 14 days after a preadmission wash-out week during which only paracetamol was allowed. Patients were assessed on admission and at the end of each treatment with respect to global pain, night pain, pain on movement, and pain on standing. Both visual analogue scales and simple descriptive scales were used to measure pain. Side effects were elicited by a nonleading question. Both methods of pain measurement gave similar results and were highly correlated. Naproxen sodium was superior to placebo in relieving global pain and depending on the method of measurement, in relieving night pain and pain on movement. Diflunisal showed no significant differences from placebo. Side effects were similar on all 3 treatments. The final preference of the patients was significantly in favour of the active treatments.

Topics: Adult; Aged; Back Pain; Clinical Trials as Topic; Diflunisal; Double-Blind Method; Female; Humans; Male; Middle Aged; Naproxen; Random Allocation; Salicylates

Topics: Acetaminophen; Back Pain; Clinical Trials as Topic; Diflunisal; Double-Blind Method; Female; Humans; Male; Middle Aged; Salicylates

Topics: Analgesics; Anti-Inflammatory Agents; Back Pain; Indoles; Muscle Relaxants, Central; Narcotics; Salicylates

Topics: Aged; Analgesics; Back Pain; Female; Humans; Melena; Salicylates

1 Nine patients with rheumatoid arthritis or non-inflammatory backache were given soluble aspirin (65 mg/kg body weight) daily. There was no significant difference between the plasma salicylate of those with rheumatoid arthritis and those with backache. 2 Two patients had plasma salicylate values that differed significantly from the remainder but neither these results nor the marginal differences between plasma salicylate levels of the others could be explained by individual variations in the capacity for excreting salicyluric acid or salicyl phenolic glucuronide. 3 Increasing the dose of aspirin in four patients demonstrated the reduced proportions of salicyluric acid and salicyl phenolic glucuronide excreted at high doses and the increased importance of unchanged salicylic acid as an excretory pathway. These findings are consistent with a limiting capacity for salicyluric acid and salicyl phenolic glucuronide synthesis and excretion. 4 The findings in one patient suggested that inter-subject variations in the capacity for producing salicyl phenolic glucuronide and salicyluric acid may have an effect on plasma salicylate levels at high doses of aspirin.

Topics: Arthritis, Rheumatoid; Aspirin; Back Pain; Female; Humans; Male; Middle Aged; Salicylates

Topics: Arthritis, Rheumatoid; Aspirin; Back Pain; Glucuronates; Humans; Kinetics; Salicylates; Time Factors; Uric Acid

Topics: Back Pain; Drug Combinations; Evaluation Studies as Topic; Gels; Heparin; Humans; Menthol; Neuralgia; Pain; Salicylates

Topics: Administration, Oral; Back Pain; Drug Tolerance; Humans; Injections, Intramuscular; Injections, Intravenous; Osteoarthritis; Rheumatic Diseases; Salicylates; Sciatica

Topics: Adult; Back Pain; Brachial Plexus Neuritis; Female; Glycosaminoglycans; Humans; Male; Middle Aged; Ointments; ortho-Aminobenzoates; Reflex Sympathetic Dystrophy; Rheumatic Diseases; Salicylates; Sulfuric Acids

Topics: Back Pain; Drug Therapy; Exercise Therapy; Humans; Low Back Pain; Muscle Relaxants, Central; Physical Therapy Modalities; Salicylates

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Back Pain; Humans; Intervertebral Disc Displacement; Phenylbutazone; Pyrazoles; Salicylates; Sciatica

Topics: Back Pain; Biological Phenomena; Humans; Physiological Phenomena; Salicylates; Skin; Skin Transplantation; Sodium Salicylate