Therapeutic efficacy of thiocolchicoside-nonsteroidal anti-inflammatory drug combination in pain management: A systematic review and cross-sectional real-world study

Abstract

BACKGROUND

Thiocolchicoside (TCC), a muscle relaxant with anti-inflammatory properties, is often used alongside nonsteroidal anti-inflammatory drugs (NSAIDs) to treat musculoskeletal pain. This synergistic approach leverages the complementary mechanisms of action, providing more effective relief for conditions such as arthritis, muscle spasms, and soft tissue injuries.

AIM

To evaluate the comparative efficacy of the combination therapy of TCC and NSAIDs vs NSAID monotherapy in pain management.

METHODS

A systematic search of PubMed and Google Scholar databases through October 2024 was performed to evaluate the effectiveness of combined TCC and NSAID therapy vs NSAIDs alone. A retrospective analysis of electronic medical records from India spanning 3 years (2020-2023) examined treatment patterns and focused on clinical outcomes including pain relief, functional improvement, and adverse effects. Key metrics for assessment included visual analog scale scores and hand-to-floor distance, with secondary outcomes assessing patient satisfaction and adverse event (AE) incidence.

RESULTS

A systematic literature search revealed seven studies, involving 1137 subjects, aligning with the eligibility criteria from a total of 833 hits. Combination therapy using parenteral TCC with NSAIDs significantly reduced pain intensity [standardised mean difference (SMD): -1.33, P < 0.001] and enhanced functional improvement (SMD: -1.08, P < 0.001) compared to NSAIDs alone. Patients on combination therapy are 6.7 times more likely to experience over 30% pain relief and 5.2 times more likely to achieve over 50% pain relief. Post surgery pain reduction and patient satisfaction were notably higher in the combination group [odds ratio (OR) = 10.14, P < 0.001]. There were no significant differences in mild/moderate AE rates between the groups (OR = 1.30, P = 0.378).

CONCLUSION

Evidence indicates that multimodal therapy, including parenteral TCC with NSAIDs, provides quicker and effective pain relief, reduces muscle spasms, and improves hand-to-floor distance compared to using NSAIDs or TCC alone.

Keywords: Thiocolchicoside; Nonsteroidal anti-inflammatory drugs; Muscle spasms; Low back pain; Muscle relaxants; Combination therapy; Pain management

Core Tip: This systematic review demonstrates the enhanced therapeutic efficacy of combining thiocolchicoside (TCC) with nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management, supported by real-world data from 156713 patients. Our analysis revealed that combination therapy provided superior pain relief, improved functional outcomes, and increased patient satisfaction compared to NSAID monotherapy, without a significant rise in adverse events. Notably, patients receiving the combination were significantly more likely to achieve clinically meaningful pain reduction. These findings support the combined use of TCC and NSAIDs in clinical practice, particularly for musculoskeletal and postoperative pain, to optimize patient outcomes and recovery.