Valium No Better Than Placebo for Acute Low Back Pain in ER

Valium No Better Than Placebo for Acute Low Back Pain in ER

By Staff

People who go to the emergency room due to lower back pain get equivalent benefit from being treated with naproxen and placebo as those who are treated with naproxen and diazepam (Valium), according to the results of a double-blind, randomized clinical trial published last week in Annals of Emergency Medicine.

“Our study contributes to the growing body of literature indicating that, in general, most medications do not improve acute lower back pain,” said lead study author Benjamin Friedman, MD, MS, of the Albert Einstein College of Medicine/Montefiore Health System in Bronx, New York. “One week after being discharged from the emergency department, lower back pain patients had improved equally, regardless of whether they were treated with naproxen and diazepam or naproxen and placebo. By three months after visiting the emergency department, most patients had recovered completely, regardless of what treatment they received.”

The scientists randomized 114 patients who came to the emergency room with new-onset lower back pain to two groups:

  1. One group was treated with a combination of naproxen (a non-prescription, non-steroidal anti-inflammatory medication) and diazepam
  2. The other group was treated with a combination of naproxen and placebo.

One week after visiting the emergency department, the diazepam group improved by 11 points on the Roland Morris Disability Questionnaire, and so did the placebo group.

After one week, 31.5 percent of the diazepam patients reported moderate or severe lower back pain, while 21.8 percent of the placebo patients did.  At three months, 12 percent of diazepam patients reported moderate or severe lower back pain, while 9 percent of placebo patients did. The differences are neither clinically or statistically significant.

“Millions of patients come to the ER every year seeking relief for back pain, which can be debilitating,” said Dr. Friedman. “Unfortunately, we have yet to come up with the silver bullet in pill form that helps them. If anything, we may be overmedicating these patients.”

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Authored by: Staff

There are 20 comments for this article
  1. Sue Survivor at 8:38 am

    I’ve never been prescribed Valium for back pain. In 25 years

  2. Tim Mason at 10:14 am

    Bob,
    The Key words are in the title of the article.
    Valium, Back Pain and ER. People go to the ER with Back pain and ask for Valium.
    The sole scope of the article was to link these words in some made up fashion.
    I think it is really that simple.

  3. Bob Schubring at 6:43 am

    The naproxen sodium treatment is highly effective in patients whose pain resulted from a calcium carbonate or phosphate buildup in a muscle or joint.

    That’s because the drug turns the calcium into a liquid that the body redistributes elsewhere or flushes out the kidneys.

    I’ve had recurring calcium buildup in my feet and in my abdomen, adjacent to my appendix. The lesions cause a grey spot to form on an X-ray image. About every twelve months, the lesions recur. I go on naproxen sodium for two weeks and the lesions resolve. I don’t take naproxen sodium for sinus pain or muscle aches because it doesn’t help me feel better. Never tried Valium for muscle aches but it seems reasonable why it would work.

    What makes this self-described study useless, is that there’s no attempt made to diagnose the cause of the back pain. If the pain was caused by something the meds help to fix, they work. If caused by something else, they don’t work. The author of this study is simply guessing.

    Useless studies like this one, crowd the journals, because we give coveted promotions to physicians and professors who publish useless studies.

    If we gave out demotions for making dumb guesses, fewer studies would be published but the quality of the studies would improve.

  4. Tim Mason at 4:30 pm

    Hi Danny,
    I think you will have to travel to Atlanta to find a board certified pain management physician.
    Do a search and find an MD that is on the State Board. Most take social security patients too.
    Make the calls, find out where you want to go and get your GP to write you a referral.
    That’s the way it works..

  5. danny harris at 10:05 am

    I need someone to help me get meds for my chronic pain in the Douglasville ga area,please help

  6. Mark Ibsen MD at 8:27 am

    “By three months after visiting the emergency department, most patients had recovered completely, regardless of what treatment they received.”

    So?
    Does this justify a nihilism of no treatment?
    By three months your rib fracture will be completely healed no matter what you do.
    Does this justify doing nothing?
    Do No Harm
    Does not equate to
    Do Nothing.

  7. Kimberly Cornilsen at 3:09 am

    Because there are at least three types of back pain. Muscular, (which valium might help with) and non muscular, (such as nerve or vertebra)

  8. Rev. Barbara Shelton at 7:33 pm

    114 is not a large number for a study of ppl going to the ER with first time back pain. And it ended 3 mos. later. Why not ask a few other ER’s to join and get a better study. I read one the other day that had a surgical study of 9. It doesn’t inspire confidence.

  9. Pharmacist Steve at 1:16 pm

    The conclusion to this study is appropriately summed up in this statement:

    The differences are neither clinically or statistically significant.

    Which strongly suggests that the study was a waste of resources and proved NOTHING …

  10. BL at 12:18 pm

    Valium can help relax skeletal muscles. If that is not the source of pain, Valium won’t help.

    I wonder if this study was done to strengthen not prescribing Valium. Although as Jean Price stated, Valium is seldom prescribed for new onset back pain.

    This study does show opiates are not being prescribed for new onset back pain like it use to be.

  11. Tim Mason at 11:26 am

    “Our study contributes to the growing body of literature”
    The growing body of literature is opioid phobic and or narcotic phobic.
    Jean you are spot on. This is an attack on diazepam, or benzo class drugs. Benzodiazapam (Valium) Lorazsepam (Ativan).
    This is an old class of drugs that work and work well. They are also very inexpensive.
    Two of the most sought after drugs in the ER are Percocet and valium.
    I know of no physician that would prescribe valium for back pain unless it was ongoing long term muscle spasms.
    We live in a chemophobic society.
    There is the back ache, back pain, chronic back pain. The later two are from organic diseases verified with MRI, CT and other tests methods. Some medications cannot be improved upon.
    Some doctors are telling their patients to “double up” on the OTC dosage of Naproxen. Not only does this cause fluid retention in your lower extremities it can ruin your kidneys.

  12. Judy at 9:56 am

    ACUTE PAIN is NOT what most of us here deal with. Acute pain is treatable, and will eventually go away. Try living with CHRONIC PAIN every day 24/7 for 25+ years.

  13. connie at 9:40 am

    Using anything that actually works at a level that is actually going to work just plain doesn’t happen anymore! Fake studies such as this one don’t help any!

  14. Kathy C at 9:33 am

    This is one more absurd “Study.” Of course Valium does nothing for “Back Pain” it only makes the patient feel better, and in relaxes them. The pain is still there, they just feel less bothered by it. This refers to “New Back Pain” so it would stand to reason that they selected people with long term issues. In the Er there would probably be a range, so this is very misleading, since all of the participants reported high pain levels 3 months out. That means every one of them had a serious problem. They were not just those weekend issues, like over exertion or over use, which would be gone in a few weeks. It is already very likely these participants were on an over the counter NSAIDs when they went to the ER.
    This is obvious Pseudo Science. This is very deceptive, and deliberately misleading. It also conflicts with my personal experience, the Use of the Pill form, in the ER too shows a deliberate attempt to mislead. The most effective use of Valium is in an IV or Injection anyway.
    Once again I am baffled as to why this kind of garbage “science” is being promoted on this Site. Just re posting this to a Site like this gives it some kind of implied credibility, that must be what is going on here. Then they can say it was posted by the Pain Report, the average person would think that added credibility. This what they do with a lot of this pseudo science, There is already a Bias, “Drugs are bad” From “South Park” then they make an outrageous claim, That claim when it reinforces a Bias, then become sensationalism. The Description of “New Back Pain’ is also problematic, since in many Cases, and from personal experience, even though I have dealt with “Back Pain” and 2 Surgeries, I would bet that other than my Specialist, each time i went to the Doctor, it was classified as “New Back Pain.’ This is one more way they they deny care, and referrals. This adds a layer of deniability. I know that 20 years of back pain and 2 back surgeries, is always “New” when I see a Physician. It is always “Ground Hog Day.”

  15. Cathy M at 9:19 am

    Firstly this talks about otherwise healthy people who’ve gotten some twist or sprain, not those with chronic pain – so as long as this doesn’t get confused, that’s fine. But I have to say I had recurring acute back pain for a decade or more, and it eventually became chronic and constant – and mostly that was because the doc said, “it’ll heal on its own”… but it was in fact getting worse!

    Second – this was about “improvement in condition”, not “immediate relief of acute pain” – which any pain sufferer can tell you is a different animal! Yeah, my hip replacement healed in time, but I’d be nuts by now if I only had to deal with it w/Tylenol!! So: they study what they want to use as evidence against opioids??

    Yes, new meta studies are showing that not a lot helps those with low back pain (http://annals.org/aim/article/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice ) – but that includes the OTC meds, too! And the non-med treatments… in fact, there is a poor result for most attempts to relieve pain… so why blame opioids (which this study SHOWS has fewer severe side effects than OTC NASAIDs and Tylenol) – why not say we still don’t understand pain – and start a “cancer war” type campaign of studies about what might mitigate pain?

    And meanwhile, let’s not use one study on a small population to generalize about a medicine (which this study didn’t, but news reports might.)

  16. Patricia Davidson at 9:13 am

    This is so ridiculous.. can’t even comment!

  17. Jean Price at 6:54 am

    What? Maybe the key here is NEW ONSET back pain…truly is this study even pertinent to those here who have way more than early onset pain? Is this even a helpful article, in light of the medications that are already being denied patients, including muscle relaxants?! Especially since general back pain can be from many difference causes…like kidney infections, kidney stones, viral muscular pain, herniated disks, strains, even things like referred pain from tubal pregnancies, or the trauma from falls and auto accidents, a lot of which brings people to the ER the day following their accident!!

    Having worked in the ER, I’ve seen people come in with all variations of pain and all levels…many used to go simply because their insurance covered the visit better than the doctors office! Some go now because they don’t have a family doctor. And there is a fear factor too, many people new to pain go because they are worried their pain will get worse! Yet, I rarely if ever saw diazepam used for new onset back pain!! So using this patient population and the fact that this is not a more targeted study allowing for specific causes of that pain makes it seem worthless to me! Just the fact that most had improved completely after three months seems to add to this for me. Long term muscle spasm pain does respond to muscle relaxants, although diazepam isn’t likely to be the one most doctor’s would prefer, and chose first!

    I would like to see the side effects report…especially the percentage of GI upset for them all, and I’m guessing it would be about the same since they all received naproxen! If pain is caused by muscle spasm alone, the diazepam would help more initially, yet there is usually lingering inflammation from most of the causes of new back pain. At any rate, I truly felt this study was meant to reflect the growing reluctance of using any type of muscle relaxant for pain…just as the reluctance to narcotics has come about!

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