Efficacy of Thiocolchicoside for Musculoskeletal Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Despite the fact that thiocolchicoside has been widely used in the treatment of musculoskeletal pain, its efficacy has never been systematically evaluated. We carried out a systematic review and meta-analysis of randomized clinical trials (RCTs) to appraise the existing evidence on the efficacy of thiocolchicoside for musculoskeletal pain management. Methods: The literature search was performed on multiple databases, extracting reports of RCTs evaluating the efficacy of thiocolchicoside compared to placebo or no exposure. The reduction in pain intensity was evaluated through between-groups mean differences (MDs) in Visual Analogue Scale (VAS) scores after the intervention. The pooled effect estimates were compared to a minimally important difference (MID) of 1 point on a scale from 0 to 10. Results: We retrieved eight RCTs, including a total of 1397 patients. All the included studies were determined as being at high risk of bias. Seven trials evaluated patients with acute low back pain. After 2-3 days of treatment, the pooled MD in VAS score was -0.49 (95%CI = -0.90; -0.09) compared to controls. After 5-7 days of treatment, the summary MD was -0.82 (95%CI = -1.46; -0.18). Conclusions: Although thiocolchicoside was found to significantly reduce patient-reported low back pain, the clinical impact was very small, as the pooled effect estimates were below the MID, and the overall certainty of evidence was very low. In light of the safety concerns raised by the European Medicine Agency, an in-depth analysis on the risk-benefit balance of thiocolchicoside is required.

Keywords: musculoskeletal pain; pain management; relaxant; thiocolchicoside.

Figure 1

PRISMA flowchart describing the selection process for the included studies.

Figure 2

Forest plot regarding the meta-analysis of mean differences in efficacy of thiocolchicoside on Visual Analogue Scale scores at 2 or 3 days from the start of the treatment, in patients with acute low back pain [6,8,9,25]. The red vertical line represents the minimal important difference (MID) of 1 point. SD, standard deviation; CI, confidence interval.

Figure 3

Forest plot regarding the meta-analysis of mean differences in the efficacy of thiocolchicoside in Visual Analogue Scale scores at 5 or 7 days from the start of the treatment in patients with acute low back pain [6,8,9,19,20,25]. The red vertical line represents the minimal important difference (MID) of 1 point. SD, standard deviation; CI, confidence interval.

Figure 4

Risk of bias assessment [6,7,8,9,19,20,25,26].