To evaluate the clinical outcome of tolperisone and thiocolchicoside in combination with aceclofenac in females with low back pain

Low back pain is defined as pain and discomfort localized below the costal margin and above inferior gluteal folds, with or without radiating to the legs.1 According to WHO, Acute low back pain is an episode that persist for less than 6 weeks and Subacute low back pain is pain between 6 to 12 weeks.2 The Global Burden of Disease Study 2016 reported that low back pain (LBP) contributes 57.6 million years lived with disability (YLD).3 The lifetime prevalence in LBP in India was found to be significantly higher in men, about 65% and 57% with women.4  According to WHO, LBP may be classified as specific and non-specific. Non-specific means that the pain experience cannot be account for another disease and is about 90% of cases. Specific LBP can be explained by an underlying disease (cancer, etc) and tissue damage (fracture, etc) or may referred from other organs (from kidney, aortic aneurysm. etc).2 The spasm-pain-spasm cycle suggest that muscle spasm caused by any injury, can induce pain and reduce range of motion. The feeling of pain can cause further muscle contractions that further increase the intensity of pain, resulting in self-perpetuation of the cycle and chronicity of LBP.5,6 According to a Canadian clinical practice guidelines 2015, the treatment recommended in acute and subacute low back pain are education and reassurance, advice to stay active, therapeutic exercise, heat and cold packs. Analgesia is provided by prescribing acetaminophen, NSAIDs, consider adding short course of muscle relaxant like benzodiazepines, cyclobenzaprine or anti-spasticity drugs as short term. Brief course of opioids can be used if pain is not in control with acetaminophen and NSAIDs.7 According to NICE guidelines, 2016 the pharmacological recommendation for treatment of low back pain consists of oral NSAIDs, paracetamol should not be used alone. Weak opioids with or without paracetamol can be used if NSAIDs is contraindicated.