Back Pain Ineffectively Treated with Pain Medications

Findings from a new study suggest that non-steroidal anti-inflammatory drugs (NSAIDS), such as aspirin and ibuprofen, offer few benefits to patients with back pain, but elicit side effects.

A systematic review published by the Annals of the Rheumatic Diseases demonstrates that only 1 in 6 patients treated with NSAIDs experienced reduced pain.

Previous studies have already deemed paracetamol ineffective in reducing back pain, while opioids have been seen to provide little benefits over placebo. This new research continued to question the efficacy of the current treatments for patients with back pain.

The investigators said that their findings show the urgent need to create new drugs that can effectively treat back pain, which is experienced by a large proportion of individuals worldwide.

"Back pain is the leading cause of disability worldwide and is commonly managed by prescribing medicines such as anti-inflammatories,” said researcher Manuela Ferreira, PhD. “But our results show anti-inflammatory drugs actually only provide very limited short term pain relief. They do reduce the level of pain, but only very slightly, and arguably not of any clinical significance."

Additionally, NSAIDs can cause adverse events, such as nausea, stomach pain, heartburn, ulcers, or liver or kidney problems. Other pain relief options like opioids have caused a serious epidemic in the United States and in Europe.

If patients are seeking prescription or over-the-counter treatments that have little clinical benefit, drug costs, and out-of-pocket expenses increase. Patients may also experience severe adverse events that could lead to additional costs from hospitalizations or other medications.

"When you factor in the side effects which are very common, it becomes clear that these drugs are not the answer to providing pain relief to the many millions of Australians who suffer from this debilitating condition every year,” Dr Ferreira said.

In the study, the investigators analyzed 35 previously conducted studies that included more than 6000 individuals. They discovered that patients taking NSAIDs were 2.5 times more likely to experience gastrointestinal symptoms, such as stomach ulcers and bleeding, according to the study. Patients were also seen to not experience improvement in pain symptoms.

Current guidelines point to NSAIDs as a second-line treatment, after paracetamol that was shown to be ineffective in other studies. The third-line of treatment for back pain is typically opioids, which carry significant dependency risks.

It is clear that current methods of pain relief are inadequate for patients with back pain, and there is a need for more effective treatments.

"Millions of Australians are taking drugs that not only don't work very well, they're causing harm. We need treatments that will actually provide substantial relief of these people's symptoms,” concluded researcher Gustavo Machado, PhD. "Better still we need a stronger focus on preventing back pain in the first place. We know that education and exercise programs can substantially reduce the risk of developing low back pain."