In recent news, big-name outlets like the New York Times and NBC have shone a necessary spotlight on back pain. Particularly, lower back pain (LBP) and how many over the counter pain medications are ineffective. Researchers have attempted to determine the true value and safety of prescription drugs over the decades in an effort to bring more clarity to this confusion. It’s rare, however, for mainstream news to confirm, in this case, that painkillers do little to help back pain. While the drug industry may not appreciate the negative press, this is an issue that the public needs to know about.
The American College of Physicians’ Guidelines for Low Back Pain
America’s opioid addiction epidemic is largely what has spurred the growing shift away from pills, over-the-counter pain relievers, and anti-inflammatories. These ineffective “fixes” for back pain have, in many cases, led to an unwanted addiction to prescriptions meds. You may wonder how this has become a nationwide epidemic, but the fact that LBP is the second greatest cause of disability in the USA helps put this unfortunate reality into perspective.
People can experience lower back pain in three different ways:
- Acute: lasts less than four weeks
- Subacute: lasts four to twelve weeks
- Chronic: lasts more than twelve weeks
Both the type and duration of low back pain should determine what kind of treatment one needs if any. The American College of Physicians (ACP) maintains that people with acute or subacute low back pain don’t necessarily need medication. But there is cause for concern if doctors are treating even the most temporary pain with synthetic drugs, knowing well the risk for addiction.
In response, the ACP published an updated set of clinical guidelines. It previously encouraged the use of medication as doctors’ go-to therapy for LBP. But Dr. Nitin Damle, president of the ACP’s board of regents said, “We need to look at therapies that are nonpharmacological first. That is a change.”
ACP’s Recommendations for Lower Back Pain for Patients and Doctors
Before arriving at the new guidelines, researchers analyzed the effects of both medicine and non-invasive methods for treating adult LBP. They found that many non-medicine and non-surgical treatments showed signs of hope for LBP. And so, the new guidelines emphasize the following alternative methods as they may improve symptoms with little risk of harm:
- Heat therapy
- Massage therapy
- Spinal manipulation
- Mindfulness-based stress reduction
- Tai chi
- Motor control exercise
- Progressive relaxation
- Electromyography biofeedback
- Low-level laser therapy
- Cognitive behavioral therapy
Most Common LBP Medications
Most people who suffer from back pain get their medications “over the counter.” You will recognize some of the more popular brand names which include:
- Acetaminophen (Tylenol)
- Ibuprofen (Motrin)
- Naproxen (Aleve)
- Diclofenac (Voltaren)
- Nabumetone (Relafen)
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Despite being readily accessible, acetaminophen and NSAIDs can make come with some severe side effects which may include: kidney issues, stomach or intestinal bleeding, and/or heart attacks or strokes. For good measure, medical professionals advise that you don’t take these drugs for more than ten days without speaking to your doctor and to avoid taking NSAIDS on an empty stomach.
Why Lower Back Pain Medications Don’t Work
To be clear, it isn’t that these medicines are completely ineffective and useless. The ACP maintains that opioids are a viable option. They just don’t want doctors to offer their patients medications until they have tried other natural or non-invasive therapies.
In phone interviews with the New York Times, ACP members have said that scans for diagnosis did more harm than good. This is because MRIs, for example, can be misleading and reveal things that may seem abnormal but are not related in any way to their low back pain.
Moreover, pain is how our bodies communicate and often urge us to pay attention. By taking something like a non-steroidal anti-inflammatory drug (NSAID) for LBP, its effects can mask the real underlying issue, potentially causing the user to overexert themselves and further injuring the underlying issue.
A 2015 study in The Spine Journal performed a systematic review and meta-analyses of how effective different pain management strategies are for sciatica. After looking at 122 relevant studies, researchers found that non-opioid medications (e.g., Tylenol, aspirin, Advil, Motrin, or Aleve) provided some positive global effect for sciatica patients, while opioids did not. In fact, opioids showed no significant effect on individuals’ pain symptoms.
Another study from the British Medical Journal explored the efficacy and safety of acetaminophen (commonly known as Tylenol) when managing spinal pain (and osteoarthritis). It included data from thousands of people who were part of randomized placebo-controlled trials.
For individuals with LBP, researchers found evidence that acetaminophen was ineffective for reducing the intensity of pain and disability or improving the quality of life in the short-term. Ultimately, the study called for doctors to reconsider prescribing acetaminophen to their patients.
In July 2016, researchers published meta-analyses in JAMA which investigated how useful opiates were for chronic back pain on a zero-to-one-hundred scale, where a rating of twenty was deemed clinically significant. Out of thirteen studies including 3,419 people, researchers found that opioids had very minimal effects on pain.
In fact, people scored the opioid treatments at a ten overall (and not twenty) which suggests that the medication had no significant impact. So for individuals who continue to tolerate opioids, they provide minimal short-term pain relief at most.
This last December 2016 study in PAIN is interesting because it used a randomized controlled trial with an open-label placebo (i.e., the participants knew they were taking a placebo). Researchers used this approach to gauge whether open-label placebos could benefit LBP patients.
The open-label placebo appeared to reduce disability and elicited significantly greater usual and maximum pain reduction by 30%. This suggests that open-label placebos may be able to help people with low back pain. However, researchers need to conduct further studies.
In his comments about the new guidelines, back pain specialist Dr. Steven J. Atlas brings up a good point: “Patients are looking for a cure. The guidelines are for managing pain.”
While a definite cure for different types of back pain isn’t yet available, the studies above make it clear that band-aid-type medications are not only ineffective but also pose a risk for addiction and overdose. So, who not try some non-invasive or natural alternatives to help ease your pain?
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Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.
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