Common Medications Probably Make Back Pain Worse

New research provides evidence that common drugs used to treat back pain may be leading to more chronic pain.

Professional guidelines already advise against using common medications such as steroids or NSAIDs such as Ibuprofen as a first line treatment for acute or chronic back pain.

Now a new study has been published which associates early use of these medicines with development of chronic back pain.

Lower back pain is a leading driver of disability across the globe, so the idea that what people commonly reach for to get some relief may be leading to worse outcomes and increased misery for millions of people should be taken seriously.

Hopefully more studies will be done, including clinical trials, which can provide evidence for causation.

In the meantime, it is already the position of numerous professional organizations, including the American Academy of Family Physicians, that non-drug treatment options such as superficial heat, massage, spinal manipulation, and other non-drug treatments should be tried before medications.

Nonpharmacologic treatment, including superficial heat, massage, acupuncture, or spinal manipulation, should be used initially for most patients with acute or subacute low back pain.

Which begs the question, if a bunch of different treatments are all shown to be equally effective for the treatment of a common condition, which treatment do you choose?Chiropractic Care Versus Medication For Chronic Lower Back Pain In Elderly PatientsThe evidence increasingly favors spinal manipulation over prescription drugs when considering patient satisfaction and…medium.com

I’d propose you pick the treatments which are both cost effective and offer the least adverse side effects. While over the counter NSAIDs are certainly cost effective, this study provides some evidence that they may not be as benign in terms of side effects as many people assume.

The tendency to use nonsteroidal anti-inflammatories persists despite their unimpressive performance. An analysis of randomized clinical trials found that these drugs had almost no benefit over placeboes in reducing low back pain.

Chiropractic care often involves several modalities recommended as first line treatments in the care of acute and subacute back pain. Typically a visit to the chiropractor will involve some superficial heat, patient education, reassurance, soft tissue treatment such as massage, spinal manipulation (chiropractic adjustment), stretching, lifestyle modification advice, or home exercise recommendations.When Your Back Hurts, Sometimes It’s Better Not Knowing Exactly WhyYou want an answer, but there are hidden costs to finding out.medium.com

While usually not as inexpensive as a $7 bottle of Advil, chiropractic care is often given some of the highest marks for patient satisfaction and appears comparable in cost effectiveness to standard medical care.

It Can Be Overwhelming

There are so many options when trying to decide what to do about a case of acute back pain. It can feel like you’re in a supermarket with too many options. Not everyone is going to respond the same way to a treatment, further confusing things. Some people love a visit to the chiropractor, other people hate getting adjusted. My wife doesn’t like acupuncture, I find it helps.

What I recommend to my patients is what I understand to be effective, low-risk, and evidence based. It is not in my scope of practice to tell a patient what medications to take or not to take, but as an aspect of informed consent I do tell my patients what other options they have for their care.

If they are in my office I am going to be biased and recommend a trial of chiropractic care for most cases of acute back pain, but they have other options such as yoga, acupuncture, exercise, topical analgesics, medications, et cetera.

Does this recent study pointing out there may be more risk involved in taking common medications confirm my bias towards conservative non-pharmacological interventions for pain? Yes. Does it mean I will stop taking Ibuprofen when I have pain? Probably not, but I might think twice the next time I reach for when my shoulder or back feels cranky.

Works Consulted:

DOI: 10.1126/scitranslmed.abj9954Common Medications Can Prolong Back Pain, Study SaysA clinical trial will be needed to verify the research, which offered a warning about taking steroids or…www.nytimes.com

doi.org/10.7326/M16–2367

Haas, Mitchell et al. “Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain.” Journal of manipulative and physiological therapeutics vol. 28,8 (2005): 555–63. doi:10.1016/j.jmpt.2005.08.006