title: Low-Dose Tramadol and Non-Steroidal Anti-Inflammatory Drug Combination Therapy Prevents the Transition to Chronic Low Back Pain.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  To determine whether low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy could prevent the transition of acute low back pain to chronic low back pain.
  
  
  BACKGROUND
  Inadequately treated early low back pain transitions to chronic low back pain occur in approximately 30% of affected individuals. The administration of non-steroidal anti-inflammatory drugs is effective for treatment of low back pain in the early stages. However, the treatment of low back pain that is resistant to non-steroidal anti-inflammatory drugs is challenging.
  
  
  METHODS
  Patients who presented with acute low back pain at our hospital were considered for inclusion in this study. After the diagnosis of acute low back pain, non-steroidal anti-inflammatory drug administration was started. Forty patients with a visual analog scale score of >5 for low back pain 1 month after treatment were finally enrolled. The first 20 patients were included in a non-steroidal anti-inflammatory drug group, and they continued non-steroidal anti-inflammatory drug therapy for 1 month. The next 20 patients were included in a combination group, and they received low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy for 1 month. The incidence of adverse events and the improvement in the visual analog scale score at 2 months after the start of treatment were analyzed.
  
  
  RESULTS
  No adverse events were observed in the non-steroidal anti-inflammatory drug group. In the combination group, administration was discontinued in 2 patients (10%) due to adverse events immediately following the start of tramadol administration. At 2 months, the improvement in the visual analog scale score was greater in the combination group than in the non-steroidal anti-inflammatory drug group (p<0.001).
  
  
  CONCLUSIONS
  Low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy might decrease the incidence of adverse events and prevent the transition of acute low back pain to chronic low back pain.
authors: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Kazuhide
authors: K
authors: Inage
authors: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Sumihisa
authors: S
authors: Orita
authors: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Kazuyo
authors: K
authors: Yamauchi
authors: Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Takane
authors: T
authors: Suzuki
authors: Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Miyako
authors: M
authors: Suzuki
authors: Department of Orthopaedic Surgery, National Hospital Organization Chiba Medical Center, Chiba, Japan.
authors: Yoshihiro
authors: Y
authors: Sakuma
authors: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Go
authors: G
authors: Kubota
authors: Department of Orthopaedic Surgery, Chiba Children's Hospital, Chiba, Japan.
authors: Yasuhiro
authors: Y
authors: Oikawa
authors: Department of Orthopaedic Surgery, Sainou Hospital, Toyama, Japan.
authors: Takeshi
authors: T
authors: Sainoh
authors: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Jun
authors: J
authors: Sato
authors: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Kazuki
authors: K
authors: Fujimoto
authors: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Yasuhiro
authors: Y
authors: Shiga
authors: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Koki
authors: K
authors: Abe
authors: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Hirohito
authors: H
authors: Kanamoto
authors: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Masahiro
authors: M
authors: Inoue
authors: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Hideyuki
authors: H
authors: Kinoshita
authors: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Kazuhisa
authors: K
authors: Takahashi
authors: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Seiji
authors: S
authors: Ohtori
keywords: Anti-inflammatory agents, non-steroidal; Low back pain; Spine; Tramadol