Expert Opinion on the Use of Analgesics for the Management of Cervical Spondylosis and Low Back Pain in Real-World Indian Settings

Manjula S *

Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India.

Krishna Kumar M

Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India.

*Author to whom correspondence should be addressed.


Abstract

Objective: The present survey-based study aims to gather clinicians' opinions regarding the use of analgesics, for the management of cervical spondylosis (CS) and low back pain (LBP) in Indian settings, both as mono and combination therapies.

Methodology: The multiple-response questionnaire-based survey, comprising 23 questions, gathered feedback on current practices, clinical observations, and experiences related to the use of analgesics, both as mono and combination therapies, in routine settings. The survey respondents were specialists with expertise in managing CS and LBP.

Results: Out of 598 clinicians, 58% preferred the combination of aceclofenac and thiocolchicoside for managing LBP. Approximately 47% of clinicians prescribed this combination to patients aged 30 to 40 years for managing LBP. About 65% of clinicians indicated that the combination of aceclofenac and thiocolchicoside is typically prescribed for more than 5 days. Around 64% of clinicians expressed the opinion that this combination relieves pain within 24 to 48 hours. Notably, about 91% of clinicians reported that they consider both minimal sedation and efficacy as important factors when prescribing muscle relaxants to patients. The majority of clinicians (77.26%) preferred using a combination of aceclofenac and paracetamol to manage arthritic pain. Furthermore, approximately 92% of the respondents stated that aceclofenac is associated with fewer gastrointestinal (GI) side effects.

Conclusion: The survey results indicate a strong preference among clinicians for the combination of aceclofenac and thiocolchicoside for managing LBP.  The survey underscores the importance of considering both sedation levels and efficacy when prescribing muscle relaxants and highlights aceclofenac and paracetamol as the preferred combination for managing arthritic pain. Additionally, the clinicians emphasize the lower incidence of gastrointestinal side effects associated with aceclofenac.

Keywords: Analgesics, cervical spondylitis, lower back pain, aceclofenac, thiocolchicoside, paracetamol


How to Cite

Manjula S, and Krishna Kumar M. 2024. “Expert Opinion on the Use of Analgesics for the Management of Cervical Spondylosis and Low Back Pain in Real-World Indian Settings”. Asian Journal of Orthopaedic Research 7 (1):58-65. https://journalajorr.com/index.php/AJORR/article/view/190.

Downloads

Download data is not yet available.

References

Kuo DT, Tadi P. Cervical spondylosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Oct 12].

Kumar S. CERVICAL SPONDYLOSIS: A Rising Trend Worldwide. IJAR. 2017;7(6): 338.

Lv Y, Tian W, Chen D, Liu Y, Wang L, Duan F. The prevalence and associated factors of symptomatic cervical Spondylosis in Chinese adults: a community-based cross-sectional study. BMC Musculoskelet Disord. 2018 Sep 11; 19:325.

Kelly JC, Groarke PJ, Butler JS, Poynton AR, O’Byrne JM. The Natural History and Clinical Syndromes of Degenerative Cervical Spondylosis. Advances in Orthopedics. 2011 Nov 28;2012: e393642.

Low back pain [Internet]. [cited 2023 Oct 12].

Available:https://www.who.int/news-room/fact-sheets/detail/low-back-pain

Shetty GM, Jain S, Thakur H, Khanna K. Prevalence of low back pain in India: A systematic review and meta-analysis. Work. 2022;73(2):429–52.

Volinn E. The epidemiology of low back pain in the rest of the world. A review of surveys in low- and middle-income countries. Spine (Phila Pa 1976). 1997 Aug 1;22(15):1747–54.

Bhattarai S. A Study on Factors Affecting Low Back Pain and Safety and Efficacy of NSAIDs in Acute Low Back Pain in a Tertiary Care Hospital of Western Nepal. J Clin Diagn Res. 2013 Dec;7(12):2752-8.

Jackson JA, Liv P, Sayed-Noor AS, Punnett L, Wahlström J. Risk factors for surgically treated cervical spondylosis in male construction workers: a 20-year prospective study. The Spine Journal. 2023 Jan;23(1):136–45.

Saragiotto BT, Machado GC, Ferreira ML, Pinheiro MB, Abdel Shaheed C, Maher CG. Paracetamol for low back pain. Cochrane Database Syst Rev. 2016 Jun 6;2016(6):CD012230.

DiPalma JR, DiGregorio GJ. Management of low back pain by analgesics and adjuvant drugs. Mt Sinai J Med. 1991 Mar;58(2):101–8.

Wewege MA, Bagg MK, Jones MD, McAuley JH, Cashin AG, Day RO, et al. Analgesic medicines for adults with low back pain: protocol for a systematic review and network meta-analysis. Systematic Reviews. 2020 Nov 4;9(1):255.

Nellika AM, Mothalampet A, Rajagopal S. A prospective study comparing the safety and efficacy of combination of aceclofenac and thiocolchicoside against aceclofenac alone in low back pain. International Journal of Basic & Clinical Pharmacology. 2018 Jan 23;7(2):333–6.

Iolascon G, Giménez S, Mogyorósi D. A Review of Aceclofenac: Analgesic and Anti-Inflammatory Effects on Musculoskeletal Disorders. J Pain Res. 2021 Nov 30;14:3651–63.

Shah D, Pal AK, Bedi G, Grover A, Purkait I, Jawdekar A, et al. Aceclofenac in Osteoarthritis - NSAID with Novel Mechanism of Action. Acta Scientific Orthopaedics. 2020; 3(12): 02-13.

Kumar S, Rani S, Siwach R, Verma P. To compare the efficacy and safety of the fixed-dose combination of thiocolchicoside and aceclofenac versus chlorzoxazone, aceclofenac, and paracetamol in patients with acute lower backaches associated with muscle spasm. Int J Appl Basic Med Res. 2014;4(2):101–5.

Desai AA, Sachdeva PD, Arora BD. A comparative study of the combined use of aceclofenac along with thiocolchicoside and aceclofenac alone in patients diagnosed of low back pain. PSM. 2011; 2(2):141-151.

P A, Geetha P, Shanmugasundaram P. Comparison of Aceclofenac and combination (Aceclofenac + Thiocolchicoside) therapy in acute low back pain patients. Research Journal of Pharmacy and Technology. 2016 Nov 28;9(11):1927–9.

Pareek A, Chandurkar N, Sharma VD, Desai M, Kini S, Bartakke G. A randomized, multicentric, comparative evaluation of aceclofenac-paracetamol combination with aceclofenac alone in Indian patients with osteoarthritis flare-up. Expert Opin Pharmacother. 2009 Apr; 10(5):727–35.

Subramanian A, Adhimoolam M, Gnanasegaran S, Mohammed MAR. Study to Assess the Prescription Pattern and Quality of Life in Osteoarthritis Patients at a Tertiary Care Hospital. JCDR. 2020 Dec;14(12):FC01-FC05.

Patel PB, Patel TK. Efficacy, and safety of aceclofenac in osteoarthritis: A meta-analysis of randomized controlled trials. Eur J Rheumatol. 2017 Mar;4(1):11–8.

Pareek A, Chandurkar N. Comparison of gastrointestinal safety and tolerability of aceclofenac with diclofenac: A multicenter, randomized, double-blind study in patients with knee osteoarthritis. Curr Med Res Opin. 2013 Jul;29(7):849–59.

Castellsague J, Riera-Guardia N, Calingaert B, Varas-Lorenzo C, Fourrier-Reglat A, Nicotra F, et al. Individual NSAIDs and Upper Gastrointestinal Complications. Drug Saf. 2012;35(12): 1127–46.