The safe way to treat low back pain

Low back pain seems to be a common thread that plagues many people. Not only is it one of the leading causes of primary care office visits in the United States, but the National Hospital Ambulatory Medical Care Survey (NHAMCS) reports that 2.63 million annual hospital emergency department visits are related to low back pain.

Despite medical advances and very strong pain medications, the problem does not seem to be letting up. And the worst part is that analgesics, anti-inflammatories and opiates are not all that effective in treatment or prevention, yet millions of people take them habitually, whether prescribed or over the counter. To make matters worse, the FDA has announced that the labels of NSAIDS must now include the dire warning that such medications can cause stroke and heart attack. Alternative therapies may be the best way forward.

Stronger medication offers no added benefit

According to the US National Library of Medicine, the most commonly used medications administered for low back pain (LBP) in emergency departments or prescribed on discharge, are opioids (61%), NSAIDS (59%), and muscle relaxants (43%). Yet a recent study proved that there was no added benefit to administering opioids with NSAIDS for low back pain.

The study, published in the Journal of the American Medical Association online, compared the functional outcomes of pain at 1 week and then again at 3 months after an emergency department visit for low back pain. They compared the outcomes in a randomized, double-blind, 3-group study of LBP patients receiving a 10-day course of: 1) naproxen (NSAID) + placebo; 2) naproxen + cyclobenzaprine (muscle relaxant); or 3) naproxen + oxycodone/acetaminophen (opioid).

For the study, all participants were prescribed 20, 500mg tablets of naproxen, to be taken twice daily. Participants were randomized into the three groups noted above, where they also received 60 tablets of either placebo; cyclobenzaprine (5 mg), or oxycodone (5 mg)/acetaminophen (325 mg). Participants were instructed to take 1 or 2 of these tablets every 8 hours, as needed for LBP. They also received a standardized 10-minute LBP educational session prior to discharge.

The results were telling. At baseline, the median pain scores were as follows: the placebo group (20); the cyclobenzaprine group (19); and the oxycodone/acetaminophen group (20).

At 1-week follow-up, the mean pain score improvement was also striking: the placebo group (9.8); the cyclobenzaprine group (10.1); and the oxycodone/acetaminophen group (11.1).

The researchers concluded that among patients with acute, nontraumatic LBP, adding muscle relaxants or opioids to treatment in addition to naproxen on its own, “did not improve functional outcomes or pain at 1-week follow-up. These findings do not support use of these additional medications in this setting.” What’s more, “measures of pain, functional impairment and use of healthcare resources were not different between the study groups at 7 days or at 3 months.”

New heart warnings on NSAID labels

It’s interesting that for low back pain not caused by traumatic injury—which is the most common and chronic—stronger pain killers and muscle relaxants were of no added value to relief. Naproxen (Aleve) by itself was most effective for relief among those who visited emergency departments for the complaint.

The scary news is that NSAIDS are known to present risk of heart attack and stroke. So even relying on the “lesser drug” is still unhealthy, and in fact potentially deadly.

The FDA recently strengthened its existing warnings about use of both prescription and over-the-counter drugs. It is mandating that the labels of NSAIDS carry the warning that their use can “increase the chance of a heart attack or stroke, either of which can lead to death.” According to their statement, these morbid effects can occur “as early as the first few weeks of using an NSAID, and the risk might rise the longer people take NSAIDs.” The warning is for those who use ibuprofen (Motrin, Advil), naproxen (Aleve), and multi-symptom cold products containing NSAIDS, for such application as pain relief and fever reduction.

The scary truth is that modern medicine, which can be a necessary evil, is not perfect or all that harmless to the human body. If a remedy for pain can cause a heart attack or stroke, where’s the balance?

Natural options = safer options

Many studies confer that most low back pain comes and goes of its own volition, whether or not one takes pain medication. And for certain, the anti-inflammatories and muscle relaxants do not prevent low back pain, which is found generally to have an emotional component to its trigger. Looking into more natural ways to prevent and reduce symptoms of LBP will perhaps keep you from running to a hospital ED or to taking health-risking pain relievers as a first course of treatment,

Previously, I have advised that you should avoid the risk of prescription painkillers by embracing natural solutions. Some of the solutions I presented in that article include topical pain creams, gels and oils, and massage, bodywork and trigger point therapies. You can read the full article here.

I’ve also previously written about the benefit of taking natural supplements for pain relief. These include nutraceuticals, homeopathies, and traditional Chinese herbs. You can read more about that here.

Finally, when all else “fails” or you are ready to accept it, I wrote about an amazing method for back pain relief called Tension Myositis Syndrome (TMS), developed by Dr. John Sarno. That article, which you can read here, summarizes how this method of treatment and prevention of LBP is based solely on knowledge, on gaining an understanding of the psycho-somatic aspects, triggers, and manifestations of the symptoms.

Regardless of which natural approach you take, the research is clear that chemical drugs are not as effective as promised at relief, they don’t prevent, and they can kill. Take as needed, and with caution, as you embrace natural methods in their place.