Acute low back pain (ALBP) is one of the most frequent musculoskeletal complaints encountered in clinical practice. Effective and timely pain relief is essential to restore mobility and prevent chronicity. Among the commonly used pharmacological options, dexketoprofen—a nonsteroidal anti-inflammatory drug (NSAID)—and methylprednisolone—a corticosteroid—are widely prescribed. This article compares the effectiveness, mechanisms, clinical applications, and safety profiles of dexketoprofen and methylprednisolone in the management of acute low back pain.

Acute low back pain affects a significant proportion of adults at some point in their lives. It is typically caused by strain, muscle spasm, ligament injury, or acute disc pathology. Pharmacologic intervention plays a central role in reducing pain, enhancing functional recovery, and improving patient quality of life.

Dexketoprofen and methylprednisolone represent two distinct approaches to managing inflammation and pain. Understanding their comparative benefits and limitations is crucial for guiding clinicians toward evidence-based treatment decisions.

Dexketoprofen

Dexketoprofen is the S-enantiomer of ketoprofen, offering enhanced analgesic and anti-inflammatory effects. It works primarily by inhibiting cyclooxygenase (COX-1 and COX-2), thereby reducing prostaglandin synthesis—key mediators of inflammation and pain.

Key Features:

• Rapid onset of action
• Effective in musculoskeletal pain
• Lower dose requirement compared to racemic ketoprofen
• Suitable for short-term acute pain management

Methylprednisolone

Methylprednisolone is a potent synthetic corticosteroid that suppresses the inflammatory cascade at multiple levels. It inhibits cytokine release, decreases vascular permeability, and reduces immune-mediated inflammatory responses.

Key Features:

• Strong anti-inflammatory effect
• Often used for acute nerve compression or severe inflammatory conditions
• Can be administered orally, intramuscularly, or intravenously

Comparative Effectiveness in Acute Low Back Pain

1. Pain Relief

Studies indicate that dexketoprofen provides rapid pain relief, often within 30 minutes to one hour after administration. It is particularly effective in cases with predominant muscle spasm or soft tissue inflammation.

Methylprednisolone, while not as rapid in analgesic onset, offers profound anti-inflammatory effect—especially beneficial in radicular pain or conditions with nerve root irritation.

2. Functional Improvement

Dexketoprofen has been shown to improve mobility and reduce pain during movement in the early stages of ALBP.

Methylprednisolone may contribute to functional recovery in patients with severe inflammatory responses or acute disc herniation.

3. Duration of Benefit

Dexketoprofen provides effective short-term relief suitable for acute episodes lasting hours to days.

Methylprednisolone’s effects extend longer due to its role in suppressing the broader inflammatory process.

Dexketoprofen

Common: gastric irritation, nausea, dyspepsia

Less common: renal side effects, gastrointestinal bleeding (higher risk in elderly or with prolonged use)

Methylprednisolone

Common: mood changes, increased appetite, transient hyperglycemia

Less common: immunosuppression, fluid retention, gastrointestinal discomfort

Caution: should be used for short duration in acute cases to minimize systemic effects

1. Nature of Pain
   • For mechanical or soft-tissue pain: Dexketoprofen is generally preferred.
   • For pain with radicular symptoms or significant inflammation: Methylprednisolone may be more effective.
2. Patient Profile
   • Patients with gastric issues should use NSAIDs cautiously.
   • Diabetic patients or those at risk of infection should be carefully monitored on corticosteroids.
3. Combination Therapy

In select cases, combining NSAIDs with a short course of corticosteroids may improve outcomes, but this approach should be individualized and monitored by a clinician.

Dexketoprofen and methylprednisolone each provide significant benefits in the management of acute low back pain, but their roles differ based on the underlying cause and clinical presentation. Dexketoprofen is ideal for rapid pain relief in mild to moderate musculoskeletal pain, whereas methylprednisolone is more effective when the inflammatory component is profound or involves nerve root irritation.

Selecting the appropriate medication requires a patient-centered approach, considering both therapeutic benefits and potential adverse effects. Further comparative clinical trials may help refine their roles in individualized treatment strategies for acute low back pain.

The authors of this article declare that they have no conflict of interest.

The authors of this article participated in the diagnosis, treatment, study design, and writing of the first version, as well as the final version of the manuscript in equal parts.