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Ouch, that back pain! This may be due to sitting too long, picking up a heavy object, a sudden slip or fall, or an aging spine – whatever the cause, sudden pain in the lower back is a common complaint.
In fact, low back pain is the leading (leading) cause of years lived with disability worldwide, with neck pain ranking 4th, according to the 2016 Global Burden of Disease study. Low back pain is said to be “acute” when the symptoms last between one and 12 weeks and “chronic” when the pain lasts three months or more.
People often look for over-the-counter pain relievers to help. But what type of pain medication is the most effective?
A new study, published Wednesday in the Journal of Orthopedic Research, tried to find out. The researchers sifted through mountains of published studies and found 18 randomized clinical trials looking specifically at lower back pain that lasted no more than 12 weeks.
The study looked at the following types of painkillers: aspirin; acetaminophen (Tylenol, Paracetamol and Panadol); and nonsteroidal anti-inflammatory drugs, called NSAIDs for short, of which there are many.
Some common NSAIDs are ibuprofen (Advil, Motrin, PediaCare); naproxen (Aleve, Naxen, Naprosyn, Stirlescent); and celecoxib (Celebrex, Elyxyb), which is not available over the counter.
The researchers also included muscle relaxants in the study, which are not available without a prescription.
The study found that the best medication for acute lower back pain was a combination of an NSAID combined with a prescription muscle relaxant – this combination was effective in reducing pain and disability after one week.
However, muscle relaxants don’t work quite the way you might think, said Dr. Eliana Cardozo, assistant professor of rehabilitation medicine. at the Icahn School of Medicine at Mount Sinai in New York.
“They don’t go to the muscle and relax it. Instead, they work in the center of our brain where they make us sleepy and that relaxes our body,” said Cardozo, who was not involved in the study.
“It’s hard to use them during the day for pain,” she added. “I personally like to use muscle relaxants for people with nighttime pain.”
Combining an NSAID with acetaminophen was associated with greater improvement than taking an NSAID alone, according to the study.
“But when I looked at the actual study data, I can’t say it really makes a big enough difference to add the two drugs — it was just a very small benefit,” Cardozo said.
Taking acetaminophen alone did not reduce pain significantly, according to the study.
The results of the study apply only to non-continuing and chronic lower back pain, pointed out the corresponding author of the study, Dr. Filippo Migliorini from the Department of Orthopedics, Traumatology and Reconstructive Surgery at the Universitätsklinikum Aachen in Germany.
Before such an intervention is recommended, the physician should be sure to rule out any “possible specific causes of pain that may require specific actions or diagnoses, for example, a history of cancer or recent trauma,” wrote Migliorini and his co-authors.
Another problem with using painkillers is that they have potentially serious side effects. Acetaminophen is not recommended during pregnancy and can cause rashes, hives, and difficulty breathing. Only 4,000 milligrams of acetaminophen can be taken per day. An overdose can lead to liver damage or liver failure, according to the National Library of Medicine.
Side effects of NSAIDs can include indigestion, diarrhea, headache, dizziness, allergic reactions, and “in rare cases, liver, kidney, or heart and circulation problems, such as heart attacks and strokes,” noted the UK’s National Health Service. .
Using NSAIDs for a period of time can lead to stomach ulcers, which can cause internal bleeding and anaemia, the NHS has said.
“If someone is completely healthy and has no other issues, then it’s fine to take NSAIDs around the clock for a week, but only for a week,” Cardozo said. “And if someone has high blood pressure, asthma, heart disease, or peptic ulcer disease, those people shouldn’t be on NSAIDs all the time.”
It’s estimated that 4 out of 5 people will suffer from lower back pain in their lifetime, according to the Cleveland Clinic. Due to the continued deterioration of the spongy discs between the back vertebrae, anyone over the age of 30 is at greater risk of low back pain.
The same is true for people who are overweight due to increased pressure on joints and discs, as well as people who smoke, drink heavily, or have a sedentary lifestyle, according to the Cleveland. Clinic. Even people with depression and anxiety are at higher risk.
According to the North American Spine Society, people who have had previous episodes of acute low back pain are at risk for ongoing chronic symptoms.
Antidepressants are not recommended for the treatment of low back pain, according to clinical guidelines developed by the society. Neither oral or intravenous steroids. “Opioid analgesics should be cautiously limited and limited to a short duration for the treatment of low back pain,” the guidelines state.
However, over-the-counter gels and creams containing capsicum or chili peppers are recommended, and it’s possible that spinal manipulation therapy may help, although studies are mixed.
Exercise is highly recommended: “Staying active is preferable and probably gives better short-term results than bed rest,” the guidelines state.
“People can start certain exercises right away, such as gentle stretches and core stabilization exercises, which can strengthen the back,” Cardozo says. “Now these aren’t sit-ups or crunches – so seeing a physical therapist to get some starting exercises can be really helpful.”