Bothered by Back Pain?
The Solution may be simple  

Duncan Shrewsbury

II FEB 26 2017

The last year or so has seen revelations about paracetamol (alone) being useless in back pain Now, another mainstay of treatment: anti-inflammatory drugs (e.g. ibuprofen) are also now being heralded as ineffective in back pain. Stronger drugs used to treat pain, such as those related to morphine, are increasingly considered dangerous, as well as unhelpful too.

With three of the big names falling away, what is left for back pain sufferers?

Back Pain

Back pain is incredibly common. Almost everyone will suffer from back pain at some point in their lives. Some a lot worse, and longer, than others . This is believed to be partly to do with the way we have evolved: the load-bearing structures of our spine are suited to us walking on all-fours, not upright on our feet. By walking on 2 legs, instead of 4, the force of our bodyweight is constantly pressed down through the spine, and supported by muscles around the spinal structures.

The majority of back pain is from the muscles. Spasms, cramping, and knotting can be so intense and severe, people often describe it as if a bone has ‘cracked’ or ‘crunched’. Occasionally, the spongy discs between the bones of the spine can bulge (‘slip’) and this, with the resultant inflammation, can irritate nerves coming from the spine, down the legs (e.g. ‘sciatica’).

Both pain from muscles and bulging discs can settle, with time, by themselves. There is often no need for any form of scan or procedure. However, it would be wise to seek medical advice with any of the following:

  • back pain after an injury or trauma
  • back pain after suffering from cancer (e.g. breast, bowel, or prostate)
  • back pain associated with ‘funny’ feelings around your bottom or genitals
  • back pain associated with any difficulty in controlling your bladder or bowel

So, what can we do?
Well, the story isn’t as simple as ‘anti-inflammatories are useless’. The research article actually concludes that they are ‘effective in spinal pain’...but not very.

We know that stronger pain-killers (e.g. codeine, tramadol and morphine) are also often not effective in back pain, especially after prolonged use. Additionally, they are addictive, and have serious consequences. They can even make chronic pain worse in many cases. All, however, may help in the short-term, such as the first 1 to 2 weeks after pain starts.

Reviews of research evidence have found that supports, and ultrasound techniques  are not effective in managing pain. There is some weak evidence to suggest that acupuncture , wrapping, and warm compresses can relieve pain in the short term .

There is hope. Yoga, Pilates, exercises and physiotherapy all offer some help with reducing pain, and improving recovery in back pain.

For a helpful guide to gentle exercises that can help in back pain, see this link from Arthritis Research UK.
 
The key messages

  • Back pain is common, and is likely to affect everyone at some point in their life, to a greater or lesser extent.
  • Restricting activity, by resting in bed, for example, is likely to prolong stiffness, and contribute to worsening or prolonging of symptoms.
  • As far as possible, normal movement and activities should be continued, despite back pain.

Any opinions above are the author's alone and may not represent those of his affiliations. Any comment is based on the best available evidence at the time of writing.  All data is based on externally validated studies unless expressed otherwise. Novel data is representative of sample surveyed. Online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice.
 
References

1. Machado et al (2015) Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ: http://www.bmj.com/content/350/bmj.h1225
2.  Wilkinson (2017) Anti-inflammatory drugs show no clinically significant effect in back pain, study suggests. Pharmaceutical Journal: http://www.pharmaceutical-journal.com/news-and-analysis/news/anti-inflammatory-drugs-show-no-clinically-significant-effect-in-back-pain-study-suggests/20202298.article
3. Park (2014). For Back Pain or Headache, Painkillers Do More Harm than Good. TIME: http://time.com/3445728/painkillers-opioids-dangerous/
 
4. Hicks (2016) Back pain guide. WebMD: http://www.webmd.boots.com/back-pain/guide/understanding-back-pain-basics  
5. Krogman (2001) The scars of human evolution. Scientific American: https://www.scientificamerican.com/article/the-scars-of-human-evolution/
 
6. Machado et al (2017) Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis. Annals of Rheumatic Disease: http://ard.bmj.com/content/early/2017/01/20/annrheumdis-2016-210597
 
7. van Dujvenbode et al (2008) Lumbar supports for prevention and treatment of low back pain. Cochrane Library: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001823.pub3/full
 
8. Ebadi et al ( 2014) Therapeutic ultrasound for chronic low-back pain. Cochrane Library: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009169.pub2/full
 
9. Furlan et al (2005) Acupuncture and dry-needling for low back pain. Cochrane Library: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001351.pub2/full
 
10.  French et al (2006) Superficial heat or cold for low back pain. Cochrane Library: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004750.pub2/full
 
11. Chaparro et al (2013) Opioids compared to placebo or other treatments for chronic low-back pain. Cochrane Library: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004959.pub4/full
 
12. Burke (2016) Painkillers can sometimes increase chronic pain. Spine Health: http://www.spine-health.com/blog/how-pain-killers-sometimes-increase-chronic-pain
 
13. Wieland et al (2017) Yoga treatment for chronic non-specific low back pain. Cochrane Library: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010671.pub2/full
 
14. Yamato (2015) Pilates for low back pain. Cochrane Library: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010265.pub2/full