Acetaminophen pills, acupuncture, massage, muscle relaxants, cannabinoids, and opioids—these are a list of treatments available for long-term lower back pain. However, there is no strong evidence that these treatments actually relieve pain, according to a new study that summarized the results of hundreds of randomized trials, as written by Nina Agrawal.
اضافة اعلان
Lower Back Pain Lower back pain affects an estimated one in four American adults and is the leading cause of disability globally. In most diagnosed cases, the pain is “nonspecific,” meaning there is no clear cause, which partly contributes to the difficulty in treating it.
Comparison of Non-Surgical Treatments In the study published this month in BMJ Evidence-Based Medicine, researchers reviewed 301 randomized trials comparing 56 non-surgical treatments for lower back pain, such as medications and exercises, against placebos. The researchers used statistical methods to combine the results of these studies and draw conclusions, a process known as a meta-analysis.
Effectiveness of Ibuprofen and Aspirin The researchers found that only one treatment, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin, was effective in relieving short-term or acute lower back pain.
Good Treatments with Little Benefit Meanwhile, five other treatments showed sufficient evidence of being good for relieving chronic lower back pain, though the benefit was small. These treatments included: exercise, spinal manipulation as performed by a chiropractor, lower back patches, antidepressants, and creams that provide a warming sensation. However, the benefits were minimal.
Steve Davidson, Associate Director of the Pain Research Center at New York University, who did not participate in the study, said: “The key takeaway from this study is that lower back pain is extremely difficult to treat. There are some treatments that were found to be effective, but those that were effective had minimal clinical benefit.”
For example, there was strong evidence that exercise could reduce chronic back pain, but it only reduced pain intensity by an average of 7.9 points on a 0-100 pain scale, which is less than what most doctors consider a clinically significant difference.
Dr. Prasad Shervalkar, Assistant Professor of Pain Medicine at the University of California, San Francisco, said: “Let’s say a patient rates their pain as a 7 out of 10. If I told you, ‘What if I could get you to a 6.3 out of 7?’ Wouldn’t that be great? Not really. And that’s the size of the effect.”
Dr. David Clark, Professor of Anesthesia at Stanford University School of Medicine and pain specialist at the Palo Alto Medical Center, said the results align with his experience as a practitioner. He added: “Most of what we try doesn’t work with patients.”
Providing “Moderate Relief” However, he and other experts stressed that the study confirmed some common treatments could provide moderate relief.
For example, Shervalkar said there are many types of NSAIDs, and they may not be used sufficiently. He added: “People may try two or three types and suffer side effects, but doctors don’t try others.”
Exercise Eases Pain Although the effect size of exercise was small, doctors still believe it likely helps alleviate back pain in the long term. Shervalkar said core exercises, like planks, help strengthen the muscles supporting the spine. Clark added that exercise has benefits beyond reducing pain intensity, such as improving strength, mobility, mood, and reducing the impact of pain on task performance.
Aidan Cashin, lead author of the study and Deputy Director of the Pain Impact Center at the Neuroscience Research Center in Australia, said the goal of the study was to identify initial treatments for lower back pain that have effects beyond placebo, which may warrant further study and those that do not. For example, there was strong evidence that paracetamol (acetaminophen) was not effective in treating acute lower back pain.
The study included a long list of treatments for which the evidence was “uncertain” due to a low number of participants or potential significant bias in the research.
Experts confirmed that this does not necessarily mean these treatments are ineffective. One flaw of the type of analysis Cashin conducted was that it pooled data from different studies and populations to simulate one large-scale trial. But in this process, a strong signal from one study about the effectiveness of a treatment might be drowned out by noise from studies that were perhaps not well designed, according to Cashin.
Heat, Massage, and Acupuncture For example, the review found that the evidence for interventions like heat (using a heating pad), massage, and acupuncture was of low certainty, but these treatments reduced pain intensity by about 20 points.
Doctors said the evidence for treatments like heat might be inconclusive, but they still recommend patients try it. Shervalkar said: “It’s cheap; it’s available; it almost doesn’t cause any harm.”
Davidson said treatments with inconclusive evidence represent a starting point for further research. He added: “What this list shows is that we have potential to work with regarding exploring different ways to treat lower back pain.”
New York Times Service
