diclofenac + thiamine + pyridoxine + cyanocobalamin

Diclofenac + thiamine + pyridoxine + cyanocobalamin is a combination therapy consisting of the nonsteroidal anti-inflammatory drug **diclofenac**, which inhibits cyclooxygenase enzymes to reduce prostaglandin synthesis and inflammation, alongside B vitamins (**thiamine (B1)**, **pyridoxine (B6)**, and **cyanocobalamin (B12)**) that provide synergistic analgesia through mechanisms including anti-inflammatory and antioxidant effects, activation of adenosine receptors, modulation of voltage-gated sodium channels (thiamine), blocking of P2X receptors by ATP (pyridoxine), and GABAergic/serotoninergic modulation (cyanocobalamin and pyridoxine).[1][2] Primarily used for **acute low back pain (LBP)** management, meta-analyses of RCTs show it significantly shortens treatment duration by ~50% compared to diclofenac alone (OR 2.23, 95% CI 1.59-3.13), with greater pain reduction on VAS scales and fewer gastrointestinal adverse events, while maintaining similar overall safety and patient satisfaction.[1][2][3] Administered orally or intramuscularly in various doses (e.g., diclofenac 50-75 mg 2-3x/day + vitamins 50-150 mg each), it has been studied for ~30 years, particularly in acute LBP, post-surgical pain, and osteoarthritis, though high-quality evidence is limited beyond acute LBP.[1][2][4][5]