title: Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial.
abstract: OBJECTIVE
  We compared pain severity and time to resumption of activities in patients with cervical strains treated with a nonsteroidal anti-inflammatory drug (NSAID), a centrally acting muscle relaxant or both.
  
  
  METHODS
  We performed a double-blinded, randomized controlled trial of adults with cervical strains from motor vehicle collisions or from falls who presented to a suburban academic emergency department (ED). Patients were randomly assigned to receive ibuprofen 800 mg, cyclobenzaprine 5 mg or both, 3 times daily as needed for up to 7 days. Outcome measures included a pain score on a 100-mm visual analog scale, pain relief scores, the time to resumption of normal activities, the use of rescue medications, and adverse outcomes. We used repeated-measures analysis of variance to compare pain relief over time. Our sample size of 20 patients in each group had a power of 80% to detect a difference of 15 mm in pain relief scores between the highest and lowest groups.
  
  
  RESULTS
  We randomly assigned 61 patients to receive ibuprofen (n = 20), cyclobenzaprine (n = 21) or both (n = 20). Mean (standard deviation) age was 34 (11) years; 58% were women and 72% were white. Although pain scores improved over time in all groups, there were no significant differences between the groups in any of the outcome measures. The rate of adverse events was also similar between groups.
  
  
  CONCLUSIONS
  Our study suggests that there is little benefit to routinely using or adding cyclobenzaprine to NSAIDs for ED patients with acute cervical strain.
authors.affiliation: Department of Emergency Medicine, Stony Brook University, Stony Brook, New York 11794-8350, United States of America.
authors.forename: S Mustafah
authors.initials: SM
authors.lastname: Khwaja
authors.forename: Max
authors.initials: M
authors.lastname: Minnerop
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
mesh_terms: D000328:Adult; D000639:Amitriptyline / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D011446:Prospective Studies; D013180:Sprains and Strains / Q000175:diagnosis / Q000188:drug therapy*; D014193:Trauma Centers; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D009125:Muscle Relaxants, Central; D000639:Amitriptyline; C004704:cyclobenzaprine; D007052:Ibuprofen