WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

Sudarsini et al. World Journal of Pharmacy and Pharmaceutical Sciences

Volume 3, Issue 4, 276-286. Research Article ISSN 2278 4357

COMPARATIVE EFFICACY AND SAFETY OF METHOCARBAMOL

AND THIOCOLCHICOSIDE IN ACUTE LOW BACK PAIN.

*Sudarsini Saravanabhavan1, Vitthal Kuchake2, Fahad I.Al-Saikhan3

1
King Saud bin Abdul-Aziz University for Health Sciences National Guard Health Affairs
(NGHA), Jeddah.K.S.A.
2
Department of Clinical Pharmacy, R. C. Patel Institute of Pharmaceutical Education &
Research, Shirpur, Maharashtra India.
3
College of Pharmacy, Salman Bin Abdul-Aziz university, Al-Kharj, K.S.A

ABSTRACT
Article Received on
28 February 2014, Purpose To evaluate the efficacy and safety of either oral
Revised on 19 March 2014, methocarbamol or thiocolchicoside in combination with paracetamol in
Accepted on 8 April 2014
acute low back pain associated with muscle spasm. Methods: Study
Design: Prospective, randomized, single blind, single centre
*Correspondence for Author comparative study. 201 patients were randomized to receive either a
Dr. Sudarsini
methocarbamol 500 mg p.o. thrice daily (group M) or a
Saravanabhavan
King Saud bin Abdul-Aziz
thiocolchicoside 8 mg p.o. twice daily (group T) with paracetamol 650
University for Health Sciences mg p.o. twice daily for 7 days. Outcome was evaluated primarily by
National Guard Health Affairs visual analogue scale (VAS) and secondarily by hand-to-floor distance,
(NGHA), Jeddah.K.S.A visual and palpable muscle spasm and Oswestry disability index (ODI)
at baseline visit, day 3, and 7 and based on patients global evaluation.
Adverse effects were monitored. Results: The pain intensity, as measured by VAS, showed
significant reduction of pain in both groups on day 3, and 7 but improvement was better in
group M as compared to group T(p<0.0001). Hand-to-floor distance and muscle spasm
decreased significantly (p<0.005 for HFD, p<0.006 for visible and p<0.0001 for palpable
spasm) on day 7 in group M as compared to group T. Mean % ODI scores improved
significantly on both day 3 and 7 (p<0.0001) in group M as compared to group T. Patients
global evaluation showed 80% of patients in group M evaluated the treatment as very good.
Both treatments were well tolerated and group T had more adverse effects, the most common
being diarrhea. Conclusion: It is concluded that either methocarbamol or thiocolchicoside in
combination with paracetamol are effective in acute LBP with spasm. Methocarbamol is

www.wjpps.com Vol 3, Issue 4, 2014. 276

Sudarsini et al. World Journal of Pharmacy and Pharmaceutical Sciences

superior in efficacy as well as safety. Running Title: Methocarbamol / Thiocolchicoside in

acute LBP

Key words: Acute / Low back pain / Muscle spasm / Muscle relaxant / Methocarbamol
/Thiocolchicoside.

INTRODUCTION
Low Back Pain (LBP) is one of the common presenting complaints in general, orthopedic and
Spine outpatient centers. Its prevalence ranges from 8% to 37% with peak prevalence
between 45 to 60 years [1, 2]. Epidemiologic studies indicate that 60-80% of the population
in industrialized countries will experience LBP at some stage in their lives and this is with the
most common cause of absenteeism [2, 3]. Muscle spasm is a typical feature of LBP due to
the/a reflex phenomenon which originates from the irritated deep structures like muscles,
ligaments, tendons, disc protrusion and/or nerve irritation. It disturbs normal function and
thereby physical mobility [4, 5, 6].

Acute back pain occurs with or without radiation to the legs. The most common causes of
LBP vary from Lumbar Strain, Trauma, Degenerative spondylitis, Lysis/ Listhesis ,
Prolapsed disc, Osteoporosis, Osteomalacia, Infection/ Tumors , Ankylosing, Spondylosis
etc.[7].Most episodes of back pain and spasm are self limiting and 90% recover within one
month[8]. Returning to normal ADL(activities of daily living) as soon as possible and
maintaining the psychometric performance during the recovery period is important in terms
of quality of life and economical aspects of the problem [4,5,9].

The most commonly used medications for the treatment of LBP include analgesics
paracetamol, acetyl salicylic acid, and other NSAIDs [10]. Muscle relaxants are also effective
in limiting the ensuing disability [11].The most commonly used muscle relaxants have
sedative like effects [9]. However, Thiocolchicoside [6, 9] and methocarbamol [12] are
effective muscle relaxants with no or little sedative effect.

Thiocolchicoside, a semi-synthetic derivative of colchicoside derived from a naturally

occurring glycoside present in the plant Gloriosa superba. Animal studies show strong
affinity for the inhibitory GABA A and strychnine sensitive glycine receptor and it produces
muscle relaxation without any subjective and objective sedative side-effects. The

www.wjpps.com Vol 3, Issue 4, 2014. 277

Sudarsini et al. World Journal of Pharmacy and Pharmaceutical Sciences

experimental models also found that thiocolchicoside possesses analgesic and anti-
inflammatory activities [13, 14].

Pharmacological studies conducted on methocarbamol demonstrated its main locus of action

to be at the internuncial neurons of the spinal cord and that it/this exerted muscle relaxation
by depression of the multisynaptic pathways in the spinal cord [15].

There is sufficient evidence to suggest the efficacy of only paracetamol in acute LBP [16].
Our hypothesis is that, combining low dose paracetamol (analgesic) with either
methocarbamol or thiocolchicoside (muscle relaxant) may act synergistically via a different
mode of action to improve LBP with spasm with lesser side effects. The purpose of the study
was to evaluate the efficacy and safety of our hypothesis.

MATERIALS AND METHODS

Study design
This was a prospective, randomized, single blind, single centre comparative study designed to
assess the efficacy and safety of oral methocarbamol as compared to oral thiocolchicoside.
The protocol was approved by the institutional Human ethical committee.

Inclusion criteria: (1) Age 18 and less than 65. (2) Patients of LBP associated with muscle
spasm. (3) Patients with signs and symptoms of muscle spasm of the lumbar region. (4) The
existence of LBP equal to or greater than 5 mm on VAS.

Exclusion criteria: (1) Pregnant and nursing women. (2) Patient/s with inadequate follow-
up. (4) Presence of any psychiatric or mental disorder which may prevent the patient from
following the study protocol. (5) Patients with severe gastrointestinal disorders. (6) Patients
with a history of Alcohol or substance abuse.

Study drug (Treatment protocol).

Patients were randomized into two treatment groups. Patients in group M are given
methocarbamol 500 mg thrice daily and paracetamol 650 mg thrice daily for 7 days. Patients
in groupT are given thiocolchicoside 8 mg twice daily and Paracetamol 650 mg thrice daily
for 7 days. All the patients were seen as outpatients. After the baseline evaluation, those
patients fulfilling all the criteria were sent for the laboratory investigation (CBC, SGPT and
serum creatinine) on the same day.

www.wjpps.com Vol 3, Issue 4, 2014. 278

Sudarsini et al. World Journal of Pharmacy and Pharmaceutical Sciences

Outcome measures
Three follow ups were done during the study period: at the beginning, on day 3 and on day 7.
The primary outcome measure was the degree of improvement in the intensity of LBP
between days 0 and 3 and between days 3 and 7 as measured by primary outcome measure
based on VAS [17]. Secondary outcome measures were functional disability using ODI [18],
hand-to-floor distance, muscle spasm, and patients global evaluation [, 9, 19].

VAS: is a 0-10 cm scale, stretching from no pain to pain as bad as it could be and is
commonly used tool in research and clinical practice. Its reliability and validity in pain
assessment has been clearly demonstrated.

Hand-to-floor distance: Also called mobility assessment in which the patient was asked to
bend forward with unflexed knee and try to touch the floor with his/her fingers; the remaining
distance was evaluated by a simple cm graduated bar (0 value at floor).

Muscle spasm: Evaluated using two semi-quantitative scales (visual and palpation
assessment) in increasing order of intensity. Visual assessment includes 1= no visual signs of
muscle spasm; 2= visible spasm of muscle without fixedantalgic gait; 3= visible spasm of
muscle with fixed- antalgic gait. The palpation scale includes 0= absence of spasm; 1= mild
spasm without evoked pain during palpation; 2= moderate spasm; 3= severe spasm of muscle
spasm with evoked pain during palpation.

Functional disability (ODI): Evaluated by information on how back pain affects ability to
manage patients ADL (activities of daily living). ODI contains 10 sections. The sections are:
pain intensity, personal care (washing/dressing), lifting, walking, sitting, standing, sleeping,
sex life (if applicable),social life and travelling. For each section the total possible score is 5:
if the first statement is marked the section score is 0, if the last statement is marked it = 5.
The total score of all sections as a percentage of the total achievable score is the ODI score.
Patients global efficacy: Evaluation was recorded at the end of the treatment by the patients
as 0= ineffective, 1= minimal effective, 2= moderately effective, 3= good, 4= very good.

Safety: Patients were monitored for laboratory and clinical adverse events based on the
baseline and final visits.

Statistical analysis: Statistical analysis was done with Statistical softwares SPSS and
PRISM. Descriptive statistics

www.wjpps.com Vol 3, Issue 4, 2014. 279

Sudarsini et al. World Journal of Pharmacy and Pharmaceutical Sciences

used for the quantitative parameters were mean and standard deviation. p values <0.05 were
considered statistically significant with a confidence interval of 0.95.

RESULTS
A total of 201 patients (105 male and 96 female) with LBP associated with muscle spasm
participated in a/the prospective randomized and comparative study on the basis of the
clinical symptoms as well as inclusion and exclusion criteria. All of them completed the
study (27 patients were excluded beforehand due to loss of follow up). There was no
significant difference regarding gender, age, and the baseline values of the outcome measures
between the two groups.

Pain assessed by VAS showed significant improvement on day 3 and 7 within the groups in
both groups. Pain intensity reduced significantly in M group as compared to T group
(p<0.0001 for both day 3 and 7). The intensity of pain reduced from 100% to 42.84% in M
group whereas it reduced to 66.18% in T group (Table 1).

A statistically significant improvement was observed in hand-to-floor distance in both groups

(p<0.0001). This improvement was observed in both groups beginning from the second visit.
But, a marked improvement (p<0.0001) was observed in M group as compared to T group
(Table 2).

The muscle spasm assessed by the visual and palpation scale was significantly and
progressively decreased in group M as compared to group T on day 7 (p<0.006 for visible
and p<0.0001 for palpable spasm) (Table 3).

The mean percent Oswestry Disability Index scores significantly improved within the groups
on day 3 and 7, (p<0.0001 for all comparisons). But, M group showed a marked improvement
in LBP related disability as compared to T group on day 7 (p<0.0001) (Table 4).

The patients opinion regarding the treatment in terms of pain evaluated as good and very
good were 53% and 36% for M group and 30% and 4% for T group. There were no
significant changes observed in safety laboratory parameters among the treatment group
during the study period. Common spontaneous adverse events reported in M group were
fever, constipation and in T group diarrhea was the most frequent (Table 5).

www.wjpps.com Vol 3, Issue 4, 2014. 280

Sudarsini et al. World Journal of Pharmacy and Pharmaceutical Sciences

Table 1: Effect of methocarbamol and thiocolchicoside on pain intensity.

Assessment Day Group M Group T p value

( n = 100) (n = 101)
Baseline 701.6 (100%) 736.5 (100%) NS
Day 3 476.9 (67.77%)* 614.2 (83.4%)* <0.0001
Day 7 302.4 (42.84%)* 487.4 (66.18%)* <0.0001
*Statistically significant compare to baseline (paired t test)
Statistically significant in compare with group T (unpaired t test).
p < 0.05 statistically significant.
NS- Not Significant (group M v/s group T)

Table 2: Effect of methocarbamol and thiocolchicoside on Mobility Assessment (Hand-

to-floor Distance)

Assessment Day Group M Group T p value

(n = 100) (n = 101)
Baseline 30.25 cm (100%) 25.91 cm (100%) NS
Day 3 19.0 cm (67.77%)* 21.30 cm (82.20)* NS
Day 7 10.62 cm (42.84%)* 16.80 cm (64.82 %)* <0.005
*Statistically significant compare to baseline (paired t test)
Statistically significant in compare with group T (unpaired t test).
p< 0.05 statistically significant.
NS- Not Significant (group M v/s group T)

Table 3: Effect of methocarbamol and thiocolchicoside to decrease in muscle spasm

(Visual and palpation)

Assessment Day Group M Group T p value

( n = 100) (n = 101)
Visual Scale
Baseline 246 .0 (100%) 156.0 (100%) NS
Day 3 183.0 (63.49%)* 133.0 (96.89%)* <0.0004
Day 7 302.4 (55.19%)* 103.0 (78.11%)* <0.006
Palpation Scale
Baseline 269.0 (100%) 174 (100%) NS
Day 3 160.0 (57.79%)* 142 (86.39%)* <0.0001
Day 7 65.0 (27.38%)* 106 (61.04%)* <0.0001
*Statistically significant compare to baseline (paired t test)
Statistically significant in compare with group T (unpaired t test).
p< 0.05 statistically significant.
NS- Not Significant (group M v/s group T)

www.wjpps.com Vol 3, Issue 4, 2014. 281

Sudarsini et al. World Journal of Pharmacy and Pharmaceutical Sciences

Table 4: Effect of methocarbamol and thiocolchicoside on Decrease in Disability (ODI)

Assessment Day Group M Group T p value

(n = 100) (n = 101)
Baseline 90.14(100%) 96.63 (100%) NS Day 3
65.62 (72.26%)* 80.63 (83.49 %)* =0.0003
Day 7 40.12 (49.69%)* 64.38 (66.46 %)* <0.0001
*Statistically significant compare to baseline (paired t test)
Statistically significant in compare with group T (unpaired t test).
p< 0.05 statistically significant.
NS- Not Significant (group M v/s group T)

Table 5: Effect of methocarbamol and thiocolchicoside on incidence of adverse events

Adverse Effect Group M Group T p value

(n = 100) (n = 101)
No. of events (%) No. of events (%)
Dizziness 0 1(0.99%) 1
Drowsiness 0 1(0.99%) 1
Fever 1 (1%) 0 0.45
Nausea 0 4 (3.96%) 0.12
Vomiting 0 5 (4.95%) 0.06
Diarrhea 0 15 (14.85%) <0.05
Constipation 1 (1%) 0 0.5
p value is based on Fishers Exact test.
p value <0.05 is significant

DISCUSSION
The immediate goal in the treatment of patients with low back pain is to relieve the
accompanying pain and muscle spasm with analgesics and/or muscle relaxants. The agency
for Health Care Policy and Research (AHCPR) back pain guidelines, released in 1994,
suggest that paracetamol is the safest and most effective medication for acute LBP. They also
suggest that non-steroidal anti-inflammatory drugs (NSAIDs), although effective, should be
used sparingly since they can cause gastrointestinal irritation, ulceration, renal or allergic
problems [16].

There is conflicting Level 3 evidence that NSAIDs are more effective than paracetamol for
acute low back pain and furthermore, when used in combination with muscle relaxant they
associated with frequent incidence of adverse events [20]. A review of clinical practice
guidelines from around the world found that almost all the guidelines recommended
paracetamol as part of the first line drugs for patients with LBP [21]. Subsequent clinical
practice guidelines for acute LBP, published in Australia [22], New Zealand [23] and Europe

www.wjpps.com Vol 3, Issue 4, 2014. 282

Sudarsini et al. World Journal of Pharmacy and Pharmaceutical Sciences

[24] have also recommended paracetamol. Paracetamol used as a rescue analgesic (dose up to
4 gm a day) [19] has strong potential for acute hepatotoxicity. In the current study, only a low
dose of paracetamol was allowed in combination with the respective study medication.

Muscle relaxants offer additional benefits for patients with acute LBP [6, 9, 11,], when used
alone or in combination with an analgesic / anti-inflammatory agent within 7 days of onset of
symptoms [25]. Commonly used muscle relaxants are central nervous system depressants
with effects like mild to moderate drowsiness, dizziness, impairment of voluntary motor
function, diarrhea, dry mouth and nausea [9].

Methocarbamol (1500mg 4 divided doses) was found to be effective in approximately 60% of

patients compared with 30% of patients in painful muscle spasm receiving placebo for 7
days. [26]. In another placebo controlled study the effect of methocarbamol was excellent in
several patients. In others, it gave no relief and represented a total of approximately 78%
beneficial effect [27].

In our study, the results of group M were dramatic in most patients (94%), where as it gave
no relief in a total of 6% patients. The mild side effects, in the form of fever and constipation,
were found in only two patients.

Thiocolchicoside alone with rescue medicine paracetamol is effective with common side
effects like headache, diarrhea, dizziness/drowsiness, and dyspepsia [6,9].Multicenter, double
blind, placebo-controlled studies with thiocolchicoside in LBP have shown significantly
improved principal outcome criteria as compared to placebo [28, 29].

In our study, the results of group T were excellent in 93.07% patients, where as it gave no
relief in a total of 6.93% patients. The side effects which were in the form of moderate
diarrhea were found in 15 patients; however this never forced a halt in the treatment. The
diarrhea stopped within the day following the 7th day. The results of this study showed that
both group M and T showed progressive improvement based on VAS, hand-to-floor distance,
muscle spasm, and disability by day 3 and 7. But, marked improvements have been shown in
group M as compared to group T. Though both groups had tolerable adverse events
Methocarbamol had a better tolerability than thiocolchicoside.

The cost of the therapy per day with thiocolchicoside was 34.8 INR, whereas the same with
methocarbamol was 5.6 INR. Thus, the treatment with group T was almost 2.5 times more

www.wjpps.com Vol 3, Issue 4, 2014. 283

Sudarsini et al. World Journal of Pharmacy and Pharmaceutical Sciences

costly than group M, rendering group M economically favorable. We recommend the use of
methocarbamol and paracetamol in acute LBP patients for our economically poor patients.

Though our study was prospective and randomized it has many limitations. No control was
done. The patients who did not respond to a (group (not sure of meaning) should have been
switched to the other group to prove its comparative efficacy with a crossover study design.

CONCLUSION
According to the results of this prospective randomized study, we conclude that
methocarbamol or thiocolchicoside in combination with paracetamol are both effective in
acute LBP with spasm. Methocarbamol is superior in efficacy and safety with cost
effectiveness. Further multicenter, randomized, double blind controlled studies with cross
over designs are required before it can be recommended as a standard primary protocol in
treating the patients with acute Low Back Pain.

ACKNOWLEDGEMENTS
The authors would like to thank Ms. Rita Walsh, English for academic purposes KSAU-HS,
NGHA, for her contribution in editing the paper.

REFERENCES
1. Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low back pain.
Orthop Clin North Am 1991; 22: 26371.
2. Gautschi OP, Hildebrandt G, Cadosch D. Acute low back pain: assessment and
management. Praxis (Bern 1994) 2008; 97:58-68.
3. Torstensen TA, Ljunggren AE, Meen HD, Odland E, Mowinckel P, Geijerstam S.
Efficiency and costs of medical exercise therapy, conventional physiotherapy and self
exercise in patients with chronic low back pain: a pragmatic, randomized, single-blinded,
controlled trial with 1 year follow- up. Spine 1998; 23:2616 24.
4. Deyo RA, Tsui-Wu YJ. Descriptive epidemiology of low back pain and its related medical
care in the United States. Spine 1987;12: 2648. Andersson GB, Svensson HO, Oden A.
The intensity of work recovery in low back pain. Spine 1983; 8:8804.
5. Soonawalla DF, Joshi N. Efficacy of Thiocolchicoside in Indian patients Suffering from
Painful Muscle Spasm. J Indian Med Assoc 2008; 106: 331-5.
6. Rubin M. Low back pain: Differentiating mechanical and medical causes. Hosp
Med.1995;3:23-32.

www.wjpps.com Vol 3, Issue 4, 2014. 284

Sudarsini et al. World Journal of Pharmacy and Pharmaceutical Sciences

7. Staiger TO, Paauw DS, Deyo RA, Jarvik JG. Imaging studies for acute low back pain:
when and when not to order them. Postgrad Med. 1999;105:161-172.
8. Ketenci A, Ozcan E, Karamursel S. Asessment of efficacy and psychomotor performance
of thiocolchicoside and tizanidine in patients with acute low back pain. Int J Clin Pract,
July 2005;59(7):764 770.
9. Malmivaara A, Hkkinen U, Aro T, Heinrichs M, Koskenniemi L, Kuosma E, Lappi S,
Paloheimo R, Servo C, Vaaranen V. "The treatment of acute low back pain-bed rest,
exercises, or ordinary activity?" N Engl J Med 1995; 332(6): 351355
10. Van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic
nonspecific low back pain. A systematic review of randomized controlled trials of the
most common interventions. Spine 1997;22:212856
11. William B. Lewis. Use of Methocarbamol in Orthopedics. California Medicine
1959;90:126-28.
12. Patat A, Klein MJ, Surjus A, Renault M, Rezvani Y, Granier J. Effects of acute and
repeated doses of two muscle relaxants chlormezanone and thiocolchicoside, on vigilance
and psychomotor performance of healthy volunteers. Human-Psychopharmacology. 1991;
6:4(285-292).
13. Janbroers JM. Review of the toxicology, pharmacodynamics and pharmacokinetics of
thiocolchicoside, a GABA-agonist muscle relaxant with anti-inflammatory and analgesic
actions. Acta Therapeutica 1987; 13: 221 50.
14. Morgan AM, Truitt EB, Little JM. Plasma levels of mephenesin, mephenesin carbamate,
guaiacol glyceryl ester and methocarbamol (AHR-85 after oral and intravenous
administration in the dog, J Amer Pharm Assn 1957:46:374.
15. Bigos S, Bowyer O, Braen G, Brown K, Deyo R, Haldeman S.Clinical Practice Guideline
Number 14: Acute Low Back Problems in Adults. Rockville, Md: Agency for Health
Care Policy and Research, Public Health
16. Service, US Dept of Health and Human Services; 1994. AHCPR publication 95-0642.
17. Huskisson EC. Measurement of pain, The Lancet 1974;2:1127- 1131.
18. Fairbank JCT, Pynsent, PB. The Oswestry Disability Index. Spine 2000; 25(22):2940-
2953.
19. Fikret T, Halil U, Nazan O, Hayri O, Kirazli Y, Afitap I, Banu K, Sqansn T, & Gunnur
B. Multicenter, randomized, double-blinded, placebo-controlled trial of thiocolchicoside
in acute low back pain. Joint Bone Spine 2003;70:356-361.

www.wjpps.com Vol 3, Issue 4, 2014. 285

Sudarsini et al. World Journal of Pharmacy and Pharmaceutical Sciences

20. Maurits W, van Tulder, Rob J PM, Scholten, Bart W, Koes and Rick A, Deyo,
Nonsteroidal Anti- Inflammatory Drugs for Low Back Pain. A Systematic Review Within
the Framework of the Cochrane Collaboration Back Review Group. Spine 2000; 25(19):
25012513.
21. Koes BW, van Tulder MW, Ostelo R, Burton K, Waddell G. Clinical guidelines for the
management of low back pain in primary care: an international comparison. Spine
2001;26:2504-2513.
22. Australian Acute Musculoskeletal Pain Guidelines Group (2003) Evidence based
management of acute musculoskeletal pain: a guide for clinicians. Australian Academic
Press Pty Ltd., Bowen Hills.
23. Gow P, Griffiths R, Grimes P et al (2004) New Zealand acute low back pain guide. ACC,
Wellington.
24. van Tulder M, Becker A, Bekkering T, Breen A, Gil del Real MT, Hutchinson A, Koes B,
Laerum E, Malmivaara A. European guidelines for the management of acute nonspecific
low back pain in primary care. Eur Spine J 2006;15:S169S191.
25. Lipetz JS, Mlanga GA. Oral medications in the treatment of acute low back pain. Occup
Med:State Art Rev 1998;13:15166.
26. Valtonen EJ. A double-blind trial of methocarbamol versus placebo in painful muscle
spasm. Current medical research and opinion 1975;3:6382-385.
27. Grisolia A, Thomson JEM. A clinical study of 46 males with low-back disorders treated
with Methocarbamol. Clinical orthopaedics and related research 1959;13:299-304.
28. Ventura R, Leonardi M, Mastropaolo C, Picci M, Vescovini R. Studio clinico controllato
sulluso del thiocolchicoside nella patologia ortopedica. Ortop Traumatol Oggi
1983;3:6573.
29. Marcel C, Rezvani Y, Revel M. Evaluation du Thiocolchicoside en monotherapie dans le
lumbago douloureux resultats dune etude randomisee contre placebo. Pres Med 1990;
24:11336.

www.wjpps.com Vol 3, Issue 4, 2014. 286