Four out of five Americans will experience lower back pain in their lifetimes, it’s the most common reason for employees to miss work, and managing it racks up a hefty bill of around US$200 billion annually.
But a chunk of those billions spent on treatment may not be worth it, with evidence mounting that pain-medication intervention is not as effective as it’s long been thought to be.
A massive meta-analysis study of lower back pain and medication has revealed that despite the enduring popularity of medicines to treat acute conditions, it’s not clear how effective the drugs actually are.
Researchers at Neuroscience Research Australia (NeuRA), the University of New South Wales (UNSW), and Brunel University London looked at 98 randomized controlled trials between 1964 and 2021, involving 15,134 adults with acute non-specific lower back pain. They examined 69 different analgesic medications that included non-steroidal anti-inflammatory drugs, acetaminophen/paracetamol, opioids, anticonvulsants, antidepressants, skeletal muscle relaxants and corticosteroids.
In the most comprehensive study of its kind, it revealed a lack of definitive evidence that analgesics worked better than a placebo, and an ever bigger lack of medical research surrounding efficacy.
“It is quite shocking that the evidence base for the effectiveness and safety of some of the most commonly used drugs for such a common condition is so fragile and incomplete,” said Dr Neil O’Connell of Brunel University London. “Our findings clearly indicate the need for larger, rigorous trials that can genuinely inform better clinical decisions."
The research highlighted the complexities in lower back pain treatment and how some drugs such as opioids can have substantial side-effects. Around 59% of people taking opioids in the US have been prescribed them for back pain.
“Despite over 60 years of research, we are still uncertain whether any analgesic medicine provides meaningful pain relief for people with low back pain,” said NeuRA’s James McAuley, also a professor at UNSW’s School of Health Sciences. “We recommend that doctors and patients take a cautious approach to managing acute low back pain with analgesic medicines until higher quality trials of head-to-head comparisons are available.”
These findings follow on from last year’s study out of McGill University, which revealed that anti-inflammatories can increase chronic pain risk by blocking the first-responder immune cells neutrophils and prolonging recovery.
Acute lower back pain, a condition that lasts for six weeks or less, is one of the leading reasons people visit their doctor. Right now, guidelines recommend superficial heat, massage, acupuncture, spinal manipulation or other physical activity as first-line treatment.
“Patients should be reassured that acute low back pain is very likely to resolve by itself over time, regardless of whether or not they take medicines,” said McAuley. “If analgesic medicines are required, our study shows that clinicians should take a cautious approach and importantly, make this decision in consultation with patients on their specific pain experience, severity of symptoms and their individual needs and preferences.”
The research was published in the journal BMJ.
Source: University of NSW
