Kocak AO, Ahiskalioglu A, Sengun E, et al. Comparison of intravenous NSAIDs and trigger point injection for low back pain in ED: A prospective randomized study. Am J Emerg Med. 2019 Jan 15. pii: S0735-6757(19)30015-4. doi: 10.1016/j.ajem.2019.01.015. (Original study)

INTRODUCTION: Low back pain (LBP) is a common complaint originating from muscles Myofascial pain syndrome (MPS) is mainly associated with trigger points (TrP) in the muscle tissue. We compared the intravenously administered non-steroidal anti-inflammatory drug (NSAID) and trigger point injection (TPI) in the treatment of LBP patients admitted to the emergency department due to pain caused by TrPs.

MATERIAL AND METHOD: After randomization, NSAID was administered intravenously in group 1 and TPIs were performed as specified by Travell and Simons in group 2. The TrPs were identified with the anamnesis and physical examination Demographic characteristics and vital signs of the patients were recorded. Pain scores were measured with the Visual Analogue Scale (VAS) at admission; and in minutes 5, 10, 15, 30, and 60.

RESULTS: There were 32 patients in group 1 and 22 patients in group 2. The demographics, vital signs, and pain scores at admission were not statistically significantly different between the groups. The pain scores decreased significantly in the TPI group. During the 60?min' follow-up period, the mean VAS pain score decreased by 0.41?±?1.30 in the TPI group and by 2.59?±?2.37 in the NSAID group (p?<?0.001). Respond the treatment was significantly higher group TPI than Group NSAID (21/22 vs 20/32 respectively, p?=?0.008).

CONCLUSION: In this small randomized study with several methodological limitations, TPI was superior to the intravenous NSAIDs in the treatment of acute LBP due to TrPs. TPI can be used in the emergency departments for the acute treatment of LBP in selected patients.

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