Trial Outcomes & Findings for Acute Low Back Pain. Topical Diclofenac and Oral Ibuprofen. (NCT NCT04611529)

NCT ID: NCT04611529

Last Updated: 2024-10-09

Results Overview

Change in Pain Disability was assessed using the Roland-Morris Disability Questionnaire (RMDQ). The RMDQ is a 24-item self-report 'Yes/no' instrument about how low-back pain affects functional activities. Each question is worth one point so scores can range from 0 (no disability) to 24 (severe disability). Change in RMDQ was measured by calculating: 'Baseline RMDQ score - RMDQ Score at 2-day (48 hour) follow-up' with positive scores being indicative of improvement (less pain disability).

Recruitment status

COMPLETED

Study phase

PHASE4

Target enrollment

198 participants

Primary outcome timeframe

Baseline to 48 hours

Results posted on

2024-10-09

Participant Flow

Enrollment commenced in March 2021 and concluded in June 2023. The study was conducted in 2 Emergency Departments (EDs) both affiliated with Montefiore Medical Center.

In total, 3281 patients were screened for participation and 198 were randomized into the study. 1 patient was excluded post-randomization due to missing RMDQ data.

Participant milestones

Participant milestones
Measure
Oral Ibuprofen + Topical Diclofenac
Oral ibuprofen 400mg Topical diclofenac 4gm Ibuprofen 400 mg: Ibuprofen 400mg Topical diclofenac: Diclofenac 1% gel 4gm
Oral Ibuprofen + Topical Placebo
Oral ibuprofen 400mg Topical placebo Ibuprofen 400 mg: Ibuprofen 400mg
Oral Placebo + Topical Diclofenac
Oral placebo Topical diclofenac 4gm Topical diclofenac: Diclofenac 1% gel 4gm
2-day Follow up
STARTED
65
66
66
2-day Follow up
COMPLETED
60
60
63
2-day Follow up
NOT COMPLETED
5
6
3
7-day Follow up
STARTED
60
60
63
7-day Follow up
COMPLETED
60
60
63
7-day Follow up
NOT COMPLETED
0
0
0

Reasons for withdrawal

Reasons for withdrawal
Measure
Oral Ibuprofen + Topical Diclofenac
Oral ibuprofen 400mg Topical diclofenac 4gm Ibuprofen 400 mg: Ibuprofen 400mg Topical diclofenac: Diclofenac 1% gel 4gm
Oral Ibuprofen + Topical Placebo
Oral ibuprofen 400mg Topical placebo Ibuprofen 400 mg: Ibuprofen 400mg
Oral Placebo + Topical Diclofenac
Oral placebo Topical diclofenac 4gm Topical diclofenac: Diclofenac 1% gel 4gm
2-day Follow up
Lost to Follow-up
5
6
3

Baseline Characteristics

Acute Low Back Pain. Topical Diclofenac and Oral Ibuprofen.

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Oral Ibuprofen + Topical Diclofenac
n=65 Participants
Oral ibuprofen 400mg Topical diclofenac 4gm Ibuprofen 400 mg: Ibuprofen 400mg Topical diclofenac: Diclofenac 1% gel 4gm
Oral Ibuprofen + Topical Placebo
n=66 Participants
Oral ibuprofen 400mg Topical placebo Ibuprofen 400 mg: Ibuprofen 400mg
Oral Placebo + Topical Diclofenac
n=66 Participants
Oral placebo Topical diclofenac 4gm Topical diclofenac: Diclofenac 1% gel 4gm
Total
n=197 Participants
Total of all reporting groups
Age, Continuous
39 years
STANDARD_DEVIATION 13 • n=5 Participants
37 years
STANDARD_DEVIATION 13 • n=7 Participants
39 years
STANDARD_DEVIATION 13 • n=5 Participants
38 years
STANDARD_DEVIATION 13 • n=4 Participants
Sex: Female, Male
Female
20 Participants
n=5 Participants
34 Participants
n=7 Participants
18 Participants
n=5 Participants
72 Participants
n=4 Participants
Sex: Female, Male
Male
45 Participants
n=5 Participants
32 Participants
n=7 Participants
48 Participants
n=5 Participants
125 Participants
n=4 Participants
Race/Ethnicity, Customized
Asian
0 Participants
n=5 Participants
0 Participants
n=7 Participants
2 Participants
n=5 Participants
2 Participants
n=4 Participants
Race/Ethnicity, Customized
Black/African-American
9 Participants
n=5 Participants
16 Participants
n=7 Participants
19 Participants
n=5 Participants
44 Participants
n=4 Participants
Race/Ethnicity, Customized
Hispanic/Latino
51 Participants
n=5 Participants
43 Participants
n=7 Participants
42 Participants
n=5 Participants
136 Participants
n=4 Participants
Race/Ethnicity, Customized
White
3 Participants
n=5 Participants
2 Participants
n=7 Participants
1 Participants
n=5 Participants
6 Participants
n=4 Participants
Race/Ethnicity, Customized
Multiracial
0 Participants
n=5 Participants
1 Participants
n=7 Participants
0 Participants
n=5 Participants
1 Participants
n=4 Participants
Race/Ethnicity, Customized
Other
1 Participants
n=5 Participants
1 Participants
n=7 Participants
0 Participants
n=5 Participants
2 Participants
n=4 Participants
Race/Ethnicity, Customized
Refused
1 Participants
n=5 Participants
3 Participants
n=7 Participants
2 Participants
n=5 Participants
6 Participants
n=4 Participants
Region of Enrollment
United States
65 participants
n=5 Participants
66 participants
n=7 Participants
66 participants
n=5 Participants
197 participants
n=4 Participants
Roland-Morris Disability Questionnaire (RMDQ) at ED visit
19 score on a scale
n=5 Participants
19 score on a scale
n=7 Participants
17 score on a scale
n=5 Participants
18 score on a scale
n=4 Participants
Duration of Low Back Pain before presentation to ED
72 hours
n=5 Participants
48 hours
n=7 Participants
48 hours
n=5 Participants
56 hours
n=4 Participants
Patients with Previous Episodes of Low Back Pain
Never Before
15 Participants
n=5 Participants
24 Participants
n=7 Participants
18 Participants
n=5 Participants
57 Participants
n=4 Participants
Patients with Previous Episodes of Low Back Pain
Few Times Before
36 Participants
n=5 Participants
29 Participants
n=7 Participants
37 Participants
n=5 Participants
102 Participants
n=4 Participants
Patients with Previous Episodes of Low Back Pain
Once a Year
14 Participants
n=5 Participants
12 Participants
n=7 Participants
9 Participants
n=5 Participants
35 Participants
n=4 Participants
Patients with Previous Episodes of Low Back Pain
Once a Month
0 Participants
n=5 Participants
1 Participants
n=7 Participants
2 Participants
n=5 Participants
3 Participants
n=4 Participants

PRIMARY outcome

Timeframe: Baseline to 48 hours

Population: 5 participants in the 'Oral ibuprofen + topical diclofenac' group; 6 participants in the 'Oral ibuprofen + topical placebo' group; and 3 participants in the 'Oral placebo + topical diclofenac' group were lost to follow-up (LTFU) prior to the 48 hour assessment timepoints.

Change in Pain Disability was assessed using the Roland-Morris Disability Questionnaire (RMDQ). The RMDQ is a 24-item self-report 'Yes/no' instrument about how low-back pain affects functional activities. Each question is worth one point so scores can range from 0 (no disability) to 24 (severe disability). Change in RMDQ was measured by calculating: 'Baseline RMDQ score - RMDQ Score at 2-day (48 hour) follow-up' with positive scores being indicative of improvement (less pain disability).

Outcome measures

Outcome measures
Measure
Oral Ibuprofen + Topical Diclofenac
n=60 Participants
Oral ibuprofen 400mg Topical diclofenac 4gm Ibuprofen 400 mg: Ibuprofen 400mg Topical diclofenac: Diclofenac 1% gel 4gm
Oral Ibuprofen + Topical Placebo
n=60 Participants
Oral ibuprofen 400mg Topical placebo Ibuprofen 400 mg: Ibuprofen 400mg
Oral Placebo + Topical Diclofenac
n=63 Participants
Oral placebo Topical diclofenac 4gm Topical diclofenac: Diclofenac 1% gel 4gm
Change in Pain Disability - Roland Morris Disability Questionnaire (RMDQ) Score
8.7 score on a scale
Interval 6.3 to 11.1
10.1 score on a scale
Interval 7.5 to 12.7
6.4 score on a scale
Interval 4.0 to 8.8

SECONDARY outcome

Timeframe: 48 hours

Population: 5 participants in the 'Oral ibuprofen + topical diclofenac' group; 6 participants in the 'Oral ibuprofen + topical placebo' group; and 3 participants in the 'Oral placebo and topical diclofenac' group were lost to follow-up prior to the 48 hour assessment timepoints; however, data was able to be collected from 3 LTFU participants in the Ibuprofen + Diclofenac group.

Worst low back was evaluated by asking patients "How would you describe your worst low back pain in the last 24 hours?" Patients were asked to describe their worst LBP using the terms "Severe", "Moderate", "Mild", or "None". Counts of participants reporting each degree of severity over the prior 24 hours are summarized.

Outcome measures

Outcome measures
Measure
Oral Ibuprofen + Topical Diclofenac
n=63 Participants
Oral ibuprofen 400mg Topical diclofenac 4gm Ibuprofen 400 mg: Ibuprofen 400mg Topical diclofenac: Diclofenac 1% gel 4gm
Oral Ibuprofen + Topical Placebo
n=60 Participants
Oral ibuprofen 400mg Topical placebo Ibuprofen 400 mg: Ibuprofen 400mg
Oral Placebo + Topical Diclofenac
n=63 Participants
Oral placebo Topical diclofenac 4gm Topical diclofenac: Diclofenac 1% gel 4gm
Worst Low Back Pain (LBP)
None
5 Participants
11 Participants
8 Participants
Worst Low Back Pain (LBP)
Mild
27 Participants
28 Participants
21 Participants
Worst Low Back Pain (LBP)
Moderate
18 Participants
14 Participants
23 Participants
Worst Low Back Pain (LBP)
Severe
13 Participants
7 Participants
11 Participants

SECONDARY outcome

Timeframe: 48 hours

Population: 5 participants in the 'Oral ibuprofen + topical diclofenac' group; 6 participants in the 'Oral ibuprofen + topical placebo' group; and 3 participants in the 'Oral placebo and topical diclofenac' group were LTFU prior to 48 hour assessment timepoints; however, data was able to be collected from 3 LTFU participants in the Ibuprofen + Diclofenac group. Data was also not collected from 1 other participant in the 'Diclofenac + Placebo' group.

Participants were asked "During the last 24 hours, have you taken any medication at all for low back pain?" and asked to respond either "Yes" or "No". Counts of participants using medication during the prior 24 hours are summarized.

Outcome measures

Outcome measures
Measure
Oral Ibuprofen + Topical Diclofenac
n=63 Participants
Oral ibuprofen 400mg Topical diclofenac 4gm Ibuprofen 400 mg: Ibuprofen 400mg Topical diclofenac: Diclofenac 1% gel 4gm
Oral Ibuprofen + Topical Placebo
n=60 Participants
Oral ibuprofen 400mg Topical placebo Ibuprofen 400 mg: Ibuprofen 400mg
Oral Placebo + Topical Diclofenac
n=62 Participants
Oral placebo Topical diclofenac 4gm Topical diclofenac: Diclofenac 1% gel 4gm
Use of Medication for Low Back Pain (LBP)
Yes
54 Participants
53 Participants
50 Participants
Use of Medication for Low Back Pain (LBP)
No
9 Participants
7 Participants
12 Participants

SECONDARY outcome

Timeframe: 48 hours

Population: Data regarding Frequency of Low Back Pain was not collected.

Frequency of Low Back Pain will be evaluated by asking patients "Over the last 24 hours, how often were you in pain?" Patients will be asked to respond to the frequency of their LBP over the prior 24 hours based on a 5-point Likert scale consisting of "Not at all", "Rarely", "Sometimes", "Usually", or "Always". This question will help determine the burdensomeness of the LBP in the patient's daily life. Counts of participants reporting each frequency will be summarized.

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 48 hours

Population: Data related to the percentage of patients who were able to return to usual activities was not collected.

The percentage of patients who were able to return to usual activities following treatment will be quantified by asking patients to provide a binary "Yes" or "No" response to a question of whether they were able to return to day-to-day activities. Results will be summarized by treatment group.

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 48 hours

Population: Data related to the number of visits to any healthcare provider was not collected.

The number of visits to any healthcare provider will be determined by asking patients whether they had any planned or emergent inpatient or outpatient visits to any healthcare provider for any reason during the course of the study. Group mean results will be summarized by treatment group.

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 48 hours

Population: Data related to treatment satisfaction was not collected.

Patient satisfaction with the treatment they received will be assessed by their response to a binary "Yes" or "No" question regarding satisfaction with their treatment. Results will be summarized by treatment group.

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 7 days

Population: 5 participants in the 'Oral ibuprofen + topical diclofenac' group; 6 participants in the 'Oral ibuprofen + topical placebo' group; and 3 participants in the 'Oral placebo + topical diclofenac' group were lost to follow-up prior to the 7-day assessment timepoints.

Change in Pain Disability was assessed using the Roland-Morris Disability Questionnaire (RMDQ). The RMDQ is a 24-item self-report questionnaire about how low-back pain affects functional activities. Each question is worth one point so scores can range from 0 (no disability) to 24 (severe disability). Change in RMDQ was measured by calculating: 'Baseline RMDQ score - RMDQ Score at 7-day follow-up with positive scores being indicative of improvement (less pain disability).

Outcome measures

Outcome measures
Measure
Oral Ibuprofen + Topical Diclofenac
n=60 Participants
Oral ibuprofen 400mg Topical diclofenac 4gm Ibuprofen 400 mg: Ibuprofen 400mg Topical diclofenac: Diclofenac 1% gel 4gm
Oral Ibuprofen + Topical Placebo
n=60 Participants
Oral ibuprofen 400mg Topical placebo Ibuprofen 400 mg: Ibuprofen 400mg
Oral Placebo + Topical Diclofenac
n=63 Participants
Oral placebo Topical diclofenac 4gm Topical diclofenac: Diclofenac 1% gel 4gm
Change in Pain Disability - Roland Morris Disability Questionnaire (RMDQ) Score
10.7 score on a scale
Interval 8.4 to 13.0
12.2 score on a scale
Interval 9.8 to 14.6
9.5 score on a scale
Interval 7.1 to 12.0

SECONDARY outcome

Timeframe: 7 days

Population: 5 participants in the 'Oral ibuprofen + topical diclofenac' group; 6 participants in the 'Oral ibuprofen + topical placebo' group; and 3 participants in the 'Oral placebo and topical diclofenac' group were lost to follow-up prior to the 7 day assessment timepoints; however data was able to be collected from 1 of the LTFU participants in the 'Ibuprofen + Diclofenac' group. Data was also not collected from 1 other participant in the 'Diclofenac + Placebo' group.

Worst low back was evaluated by asking patients "How would you describe your worst low back pain in the last 24 hours?" Patients were asked to describe their worst LBP using the terms "Severe", "Moderate", "Mild", or "None". Counts of participants reporting each degree of severity over the prior 24 hours are summarized.

Outcome measures

Outcome measures
Measure
Oral Ibuprofen + Topical Diclofenac
n=61 Participants
Oral ibuprofen 400mg Topical diclofenac 4gm Ibuprofen 400 mg: Ibuprofen 400mg Topical diclofenac: Diclofenac 1% gel 4gm
Oral Ibuprofen + Topical Placebo
n=60 Participants
Oral ibuprofen 400mg Topical placebo Ibuprofen 400 mg: Ibuprofen 400mg
Oral Placebo + Topical Diclofenac
n=62 Participants
Oral placebo Topical diclofenac 4gm Topical diclofenac: Diclofenac 1% gel 4gm
Worst Low Back Pain (LBP)
None
20 Participants
24 Participants
15 Participants
Worst Low Back Pain (LBP)
Mild
21 Participants
23 Participants
24 Participants
Worst Low Back Pain (LBP)
Moderate
13 Participants
9 Participants
16 Participants
Worst Low Back Pain (LBP)
Severe
7 Participants
4 Participants
7 Participants

SECONDARY outcome

Timeframe: 7 days

Population: 5 participants in the 'Oral ibuprofen + topical diclofenac' group; 6 participants in the 'Oral ibuprofen + topical placebo' group; and 3 participants in the 'Oral placebo and topical diclofenac' group were lost to follow-up prior to the 7 day assessment timepoints; however data was able to be collected from 1 of the LTFU participants in the 'Ibuprofen + Diclofenac' group.

Participants were asked "During the last 24 hours, have you taken any medication at all for low back pain?" and asked to respond either "Yes" or "No". Counts of participants using medication during the prior 24 hours are summarized.

Outcome measures

Outcome measures
Measure
Oral Ibuprofen + Topical Diclofenac
n=61 Participants
Oral ibuprofen 400mg Topical diclofenac 4gm Ibuprofen 400 mg: Ibuprofen 400mg Topical diclofenac: Diclofenac 1% gel 4gm
Oral Ibuprofen + Topical Placebo
n=60 Participants
Oral ibuprofen 400mg Topical placebo Ibuprofen 400 mg: Ibuprofen 400mg
Oral Placebo + Topical Diclofenac
n=63 Participants
Oral placebo Topical diclofenac 4gm Topical diclofenac: Diclofenac 1% gel 4gm
Use of Medication for Low Back Pain (LBP)
Yes
33 Participants
31 Participants
35 Participants
Use of Medication for Low Back Pain (LBP)
No
28 Participants
29 Participants
28 Participants

SECONDARY outcome

Timeframe: 7 days

Population: Data regarding Frequency of Low Back Pain was not collected.

Frequency of Low Back Pain will be evaluated by asking patients "Over the last 24 hours, how often were you in pain?" Patients will be asked to respond to the frequency of their LBP over the prior 24 hours based on a 5-point Likert scale consisting of "Not at all", "Rarely", "Sometimes", "Usually", or "Always". This question will help determine the burdensomeness of the LBP in the patient's daily life. Counts of participants reporting each frequency will be summarized.

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 7 days

Population: Data related to the percentage of patients who were able to return to usual activities was not collected.

The percentage of patients who were able to return to usual activities following treatment will be quantified by asking patients to provide a binary "Yes" or "No" response to a question of whether they were able to return to day-to-day activities. Results will be summarized by treatment group.

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 7 days

Population: Data related to the number of visits to any healthcare provider was not collected.

The number of visits to any healthcare provider will be determined by asking patients whether they had any planned or emergent inpatient or outpatient visits to any healthcare provider for any reason during the course of the study. Group mean results will be summarized by treatment group.

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 7 days

Population: Data related to treatment satisfaction was not collected.

Patient satisfaction with the treatment they received will be assessed by their response to a binary "Yes" or "No" question regarding satisfaction with their treatment. Results will be summarized by treatment group.

Outcome measures

Outcome data not reported

Adverse Events

Oral Ibuprofen + Topical Diclofenac

Serious events: 0 serious events
Other events: 4 other events
Deaths: 0 deaths

Oral Ibuprofen + Topical Placebo

Serious events: 0 serious events
Other events: 3 other events
Deaths: 0 deaths

Oral Placebo + Topical Diclofenac

Serious events: 0 serious events
Other events: 1 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Oral Ibuprofen + Topical Diclofenac
n=60 participants at risk
Oral ibuprofen 400mg Topical diclofenac 4gm Ibuprofen 400 mg: Ibuprofen 400mg Topical diclofenac: Diclofenac 1% gel 4gm
Oral Ibuprofen + Topical Placebo
n=60 participants at risk
Oral ibuprofen 400mg Topical placebo Ibuprofen 400 mg: Ibuprofen 400mg
Oral Placebo + Topical Diclofenac
n=63 participants at risk
Oral placebo Topical diclofenac 4gm Topical diclofenac: Diclofenac 1% gel 4gm
Nervous system disorders
Drowsiness
0.00%
0/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
3.3%
2/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
0.00%
0/63 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
Skin and subcutaneous tissue disorders
Pruritis
0.00%
0/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
1.7%
1/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
0.00%
0/63 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
Musculoskeletal and connective tissue disorders
Muscle Cramp
0.00%
0/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
0.00%
0/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
1.6%
1/63 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
General disorders
Chills
1.7%
1/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
0.00%
0/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
0.00%
0/63 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
Gastrointestinal disorders
Diarrhea
1.7%
1/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
0.00%
0/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
0.00%
0/63 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
Nervous system disorders
Headache
1.7%
1/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
0.00%
0/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
0.00%
0/63 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
Nervous system disorders
Dizziness
1.7%
1/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
0.00%
0/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
0.00%
0/63 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
Respiratory, thoracic and mediastinal disorders
Dyspnea
1.7%
1/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
0.00%
0/60 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.
0.00%
0/63 • From baseline up to 7 days following treatment
Medication-related adverse events were elicited by asking whether the study medications caused any new symptoms.

Additional Information

Dr. Benjamin Friedman

Montefiore Medical Center

Phone: 718-920-6626

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place