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Pain Research and Treatment
Volume 2012 (2012), Article ID 154781, 8 pages
Review Article

Antineuropathic and Antinociceptive Drugs Combination in Patients with Chronic Low Back Pain: A Systematic Review

1Centro di Chirurgia Ricostruttiva, Istituto Ortopedico I.R.C.C.S. Galeazzi, Via R. Galeazzi 4, 20161 Milano, Italy
2Centro di Medicina del Dolore, Casa di cura S. Pio X, Fondazione Opera San Camillo, Via F. Nava 31, 20159 Milano, Italy

Received 8 January 2012; Revised 4 February 2012; Accepted 8 February 2012

Academic Editor: Young-Chang P. Arai

Copyright © 2012 Carlo Luca Romanò et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. Chronic low back pain (LBP) is often characterized by both nociceptive and neuropathic components. While various monotherapies have been reported of only limited efficacy, combining drugs with different mechanisms of action and targets appears a rational approach. Aim of this systematic review is to assess the efficacy and safety of different combined pharmacological treatments, compared to monotherapy or placebo, for the pharmacological treatment of chronic LBP. Methods. Published papers, written or abstracted in English from 1990 through 2011, comparing combined pharmacological treatments of chronic LBP to monotherapy or placebo were reviewed. Results. Six articles met the inclusion criteria. Pregabalin combined with celecoxib or opioids was shown to be more effective than either monotherapy. Oxycodone-paracetamol versus previous treatments and tramadol-paracetamol versus placebo were also reported as effective, while morphine-nortriptyline did not show any benefit over any single agent. Conclusions. In spite of theoretical advantages of combined pharmacological treatments of chronic LBP, clinical studies are remarkably few. Available data show that combined therapy, including antinociceptive and antineuropathic agents is more effective than monotherapy, with similar side effects.