Low back pain is one of the leading causes of missed work days, disability, and doctors visits. With more than 80% of people being affected by low back pain at some point in their lives, people often wonder how they can treat low back pain themselves.
In most cases, low back pain will go away on its own after a short while. Many cases of low back pain are referred to as “non-specific” back pain, which means there isn’t an obvious cause of the pain. Some cases end up lasting for a long time, or recur from time to time. This type of low back pain, referred to as “chronic” low back pain, can be a challenge to treat.
Treating Low Back Pain
A review of clinical guidelines from around the world all recommend pretty much the same things. For patients who are dealing with acute low back pain, the guidelines recommend returning to normal activities, avoiding bed rest, and using nonsteroidal anti-inflammatory drugs (NSAIDs) and/or weak opioids for a short period of time. For those who are suffering from chronic low back pain, guidelines recommend exercise therapy, psychosocial interventions and NSAIDs. Some guidelines also include the use of antidepressants.
For both types of low back pain, staying active and keeping moving are two of the most effective things that sufferers can do. But what happens when you just need a little extra pain relief in order to feel like you can move without feeling a lot of pain?
Typically, pain is there to remind us to not use a certain part of our body that has been injured, so that we don’t cause further harm. Using painkillers masks those feelings of pain, and can cause us to overwork that injured body part — not giving it the rest that it needs.
So what are we supposed to do when all of the guidelines tell us to keep exercising and moving? How can you get to the point where you can do that without feeling like you want to cry when you move? That’s where the pharmaceutical interventions come in. Pain killers are usually only recommended in addition to active treatments such as exercise and movement. Their goal is to help you start moving again, and they shouldn’t be used over an extended period of time.
Over-The-Counter Pain Killers
If we take a look at the use of NSAIDs and weak opioids, people often want to know which ones to use, when to use them, and how long to use them for. Let's take a closer look at each category of pain medication, commonly used to treat low back pain, and see how they work and what to be on the look out for when it comes to side effects or potential drug interactions.
NSAIDs, such as ibuprofen, diclofenac, and naproxen, are the most common medications prescribed for the treatment of low back pain. NSAIDs block the production of certain body chemicals that cause inflammation (swelling) and relieve pain. These drugs are available over the counter, at low doses, and are commonly taken in tablet form. They are also available as injections, but that method isn’t really recommended because they can cause bleeding or inflammation at the needle entry point.
NSAIDs can cause gastrointestinal (stomach) upsets and, if used long term, can even cause stomach ulcers. They also carry a small risk of causing certain heart conditions. NSAIDs are not recommended for those who have kidney failure.
A different class of anti-inflammatory medication, COX-2 inhibitors, (etoricoxib and celecoxib) has similar effects, although these medications are not approved for the treatment of low back pain. Because of the side effects associated with these medications, it is a good idea to speak with your doctor before using them to treat low back pain, and to ensure that, if you do take medication, it is taken in conjunction with an exercise program, and not used long term.
Another common medication that people often use to treat their low back pain is acetaminophen (paracetamol). Unfortunately, when it comes to low back pain, studies have shown that taking acetaminophen appears to be no more effective than taking a placebo (a fake medication). If you do choose to take acetaminophen, it is important to know that higher doses damage your liver, and can even cause liver failure.
Muscle relaxants work to relieve pain by reducing tension in the muscles. While this type of medication is believed to help relieve acute back pain, their effectiveness in treating chronic low back pain has yet to be proven. You should know that muscle relaxants can cause drowsiness which can increase the risk of falls in older adults, and can affect your ability to drive or work. Some muscle relaxants, such as benzodiazepines, can also be addictive.
When low back pain treatment doesn’t respond to exercise and NSAIDs, some doctors prescribe opioids. Opioids come in many different strengths, ranging from weak to very strong. Tramadol is one of the weaker opioids, while Morphine is a very strong one. Until fairly recently, opioids were commonly prescribed by doctors for chronic low back pain. These drugs were believed to work very well for acute pain, but recent studies have shown that they usually don’t work better than NSAIDs.
While opioids can cause side effects such as nausea and constipation, it is their powerful addictive properties and accompanying risk of life-threatening overdose that has come into the spotlight in recent years with the opioid overdose crisis. This has led to a serious reduction in the number of opioid prescriptions and the investigation of alternative treatment options. If you do require an opioid then it is a good idea to seek advice from a pain specialist with extensive experience in working with opioids.
When you examine the extensive research that has emerged over the past 10 years or so, we are increasingly seeing little to no additional benefit of these medications over placebo. And, with so many side-effects and health concerns, there is a growing trend of using alternative therapies in place of pharmacological interventions when treating chronic low back pain (see our blog on Alternative Treatments for Low Back Pain.
Today, holistic approaches including exercise therapy, stress management, psychosocial approaches, PNE (Pain Neuroscience Education), and nutrition are becoming the gold standard for the treatment of low back pain and there is a growing body of research that supports these therapies. So if you are unlucky enough to suffer from low back pain, it might be fun to try something new instead of reaching for your typical bottle of Advil.
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