Aceclofenac with Muscle Relaxant for Spondylosis and Disc Prolapse
Aceclofenac 100 mg twice daily is an appropriate NSAID choice for spondylosis and disc prolapse, but muscle relaxants (specifically benzodiazepines) should be avoided as they provide no benefit and actually worsen outcomes compared to NSAIDs alone. 1
NSAID Selection and Dosing
Aceclofenac is a validated treatment option for inflammatory spinal conditions:
Aceclofenac 100 mg twice daily has demonstrated equivalent efficacy to tenoxicam, naproxen, and indomethacin in ankylosing spondylitis and other inflammatory spinal conditions, with a favorable gastrointestinal safety profile. 2, 3
For degenerative spinal conditions with spondylosis, NSAIDs are recommended as first-line drug treatment for pain and stiffness. 4
Continuous daily dosing is preferred over "as-needed" dosing for persistently active symptomatic disease, as continuous NSAID therapy may reduce radiographic progression. 4, 5
If aceclofenac provides inadequate relief after 1-2 weeks, trial 2-3 different NSAIDs at optimal doses before concluding NSAID failure. 5, 6
Critical Evidence Against Muscle Relaxants
Benzodiazepines (the most commonly prescribed muscle relaxants) are contraindicated in lumbar disc prolapse:
A randomized, placebo-controlled trial specifically examining diazepam in lumbar disc prolapse with sciatica demonstrated that benzodiazepines provided no benefit and actually worsened outcomes. 1
Patients receiving placebo (physiotherapy + analgesics alone) had shorter hospital stays (8 vs. 10 days, p=0.008) and twice the probability of >50% pain reduction compared to those receiving benzodiazepines. 1
The study concluded that benzodiazepines should not be used routinely in patients treated with mechanical physiotherapy for lumbar disc prolapse. 1
Recommended Treatment Algorithm
Start with aceclofenac 100 mg twice daily (continuous dosing) plus physical therapy:
Combine NSAID therapy with active supervised exercise programs, which are strongly recommended and provide significant functional improvement. 4, 5, 6
Active physical therapy interventions (supervised exercise) are preferred over passive modalities (massage, ultrasound, heat). 4
Avoid systemic glucocorticoids for axial spinal disease, as they are strongly recommended against. 4, 5, 7
Gastrointestinal Protection Strategy
For patients with GI risk factors, add gastroprotection:
Proton pump inhibitors (PPIs) are first-line for gastroprotection, equally effective as misoprostol but better tolerated. 5, 6
Aceclofenac has a particularly favorable GI tolerability profile among NSAIDs, with lower incidence of gastrointestinal adverse effects and reduced withdrawal rates. 2
Common Pitfalls to Avoid
Do not prescribe benzodiazepines or other muscle relaxants for lumbar disc prolapse, as evidence demonstrates harm rather than benefit. 1
Do not use intermittent "as-needed" dosing for ongoing symptoms; continuous daily NSAID therapy is preferred for active disease. 4, 5
Do not use systemic steroids for axial spinal conditions. 4, 5, 7
Ensure cardiovascular, gastrointestinal, and renal risks are assessed before prescribing NSAIDs. 4