Karmakar A, Jaiswal A, Mandal S, Khan AA, Mitra M. Therapeutic efficacy of thiocolchicoside-nonsteroidal anti-inflammatory drug combination in pain management: A systematic review and cross-sectional real-world study. World J Orthop 2025; 16(8): 106769 [DOI: 10.5312/wjo.v16.i8.106769]
Corresponding Author of This Article
Monjori Mitra, Professor, Visiting Professor, Department of Pediatrics, Institute of Child Health, 11 Biresh Guha Street, Kolkata 700017, West Bengal, India. monjorimr@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Aug 18, 2025; 16(8): 106769 Published online Aug 18, 2025. doi: 10.5312/wjo.v16.i8.106769
Therapeutic efficacy of thiocolchicoside-nonsteroidal anti-inflammatory drug combination in pain management: A systematic review and cross-sectional real-world study
Arnab Karmakar, Akash Jaiswal, Soham Mandal, Afroz Ahmed Khan, Monjori Mitra
Arnab Karmakar, Department of Orthopedics, Institute of Post Graduate Medical Education and Research, Kolkata 700020, West Bengal, India
Akash Jaiswal, Department of Orthopedics, Apollo Hospital, Secunderabad 500025, Telangana, India
Soham Mandal, Department of Orthopedics, Manipal Hospital, Kolkata 700106, West Bengal, India
Afroz Ahmed Khan, Department of Orthopedics, Era's Lucknow Medical College and Hospital, Lucknow 226003, Uttar Pradesh, India
Monjori Mitra, Department of Pediatrics, Institute of Child Health, Kolkata 700017, West Bengal, India
Author contributions: Mitra M provided the resources; Karmakar A, Jaiswal A, Mandal S, Khan AA, and Mitra M conceived the study, designed the methodology, performed the formal analyses, validated the data, participated in project administration, wrote, reviewed, and edited the manuscript; All authors have reviewed the manuscript and agreed to its publication.
Supported by CORONA Remedies Limited.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Monjori Mitra, Professor, Visiting Professor, Department of Pediatrics, Institute of Child Health, 11 Biresh Guha Street, Kolkata 700017, West Bengal, India. monjorimr@gmail.com
Received: March 6, 2025 Revised: June 6, 2025 Accepted: July 7, 2025 Published online: August 18, 2025 Processing time: 155 Days and 0.6 Hours
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.
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.
