Spine University’s Guide to

Low Back Pain and NSAIDs

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Spine University's Guide to Low Back Pain and NSAIDs

Compliments of: Spine University

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Spine University's Guide to Low Back Pain and NSAIDs

Introduction Nonsteroidal anti-inflammatory drugs (NSAIDs) are a common type of pain reliever that can be bought over-the-counter or with a prescription. Which type they are depends on the strength and type of the medication. The most common over-the-counter NSAIDs are ibuprofen (such as Advil), ASA (Aspirin), and naproxen (such as Aleve). Some people add acetaminophen (Tylenol®) (also called paracetamol, to the NSAID group, but it's not a true NSAID. Common prescription NSAIDs includes anaproxin, dicolofenac, and celecoxib. What do NSAIDs do? What parts make up the spine and neck? Unlike medications like morphine or similar pain medications, which interrupt the pain signals between the injury and the brain, NSAIDs directly target the site of the pain. The drugs then work to reduce inflammation (swelling), which can be pressing on nerves and other tissues, causing the pain. What are NSAIDs used for? NSAIDs are used for many conditions ranging from rheumatoid arthritis to menstrual cramps to back pain. Their popularity soared when they became available in the mid-1980s and people found them to be quite effective at relieving their every day type of pain. According to an article written by Gerard Malanga, MD, in the early 1980s, almost one in seven people in the United States were taking an anti-inflammatory of some type, but by 1986, NSAIDs became a billion dollar industry worldwide, with nearly 100 million prescriptions being written. Back pain and NSAIDs Lower back pain is a very common problem in the developed world. It's one of the most frequently seen pain issues in a doctor's office or clinic. Low back pain doesn’t cause only pain though. It causes lots of other

issues like missed work, lowered productivity for the employers, higher health care costs, medical expenses, and disability in many cases. If the pain becomes chronic, there may be other issues, such as depression, isolation, and other health issues that may result. Because back pain is so common and can be so debilitating for some people, researchers have been searching for a long time to find ways to relieve the pain or at least make it manageable when it is acute, or when it just happened. It's during this acute period that the window is open for the most effective treatment. Once back pain becomes chronic (lasting longer than three to six months) it becomes much more difficult to treat. One of the major problems with treating back pain is that there's no one size fits all approach. If you have appendicitis, you can have surgery. If you have an infection, you can usually take antibiotics. But with back pain, it's not so cut and dry. Researchers have been trying to find a way to tell which types of treatments help which types of patients, but they don’t seem to have made too much headway in this department. Because NSAIDs have two roles, reducing inflammation and reducing pain, they are one of the most commonly recommended or prescribed first-line treatments to patients with low back pain. First-line treatments are those that doctors use first when treating a patient. In the case of lower back pain, while first-line treatments may not always solve the problem, if they do work and reduce the low back pain, the patient may be more able to get up and about, moving normally and strengthening the back to help it heal. NSAIDs for back pain that doesn't include sciatica are often very effective. Sciatica itself isn't a disorder, but is the result of certain types of back injury. With some injuries, the vertebrae may press on the sciatic nerve, which runs from your lower back down the back of your hip, through your buttock and down the back of your leg. If your back pain includes sciatica, using NSAIDs might not be as effective as for those who don’t have sciatica.

NSAID Guidelines for Treating Back Pain Guidelines that have been instituted for the management of acute back pain recommend NSAIDs as one of the first-line treatments for low back pain. In many cases, acetaminophen may be tried first, followed by a true NSAID. It’s very important to use the medication properly. The most efficient way to use an Compliments of: Spine University

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Spine University's Guide to Low Back Pain and NSAIDs

NSAID for lower back pain is to use it during the first week or two after the injury, while the inflammatory process is at its worst. NSAIDs should be taken regularly, as directed by your doctor in order to keep the level of medications up in your blood system. That means taking them every X number of hours as recommended. If you take them only now and again, the level of medication in your blood dips and rises, making it harder to keep the inflammation at the injury at bay. Researchers don't recommend that different NSAIDs be mixed because of the side effects. Since they all have similar side effects, they would just add up on top of each other, increasing the risk of complications. However, since acetaminophen isn't a true NSAID, some doctors do recommend using both an NSAID and acetaminophen if it's warranted. As well, it's important not to take NSAIDs for too long. Usually, three weeks of regular use is the limit in order to prevent complications. Different Type of NSAID Celecoxib, a prescription medication, was listed above as one the NSAIDs, but it is technically in a different group called a COX-2 inhibiting NSAID. When COX-2 inhibitors were developed, the medical community welcomed them because, while traditional NSAIDs may cause problems with the stomach, COX-2 inhibiting NSAIDs have a lower risk this. Yet, both medications do the same thing: reduce inflammation to help relieve pain. However, after celecoxib was used for a few years among the general population requiring pain relief, there were many reports of complications affecting the heart. This resulted in a few COX-2 inhibitors, like Vioxx, being pulled of the market. Others are still available and are providing relief to many people who have lower back pain. At this point, they are still considered to be safe.

The prescribing doctors do need to be careful when deciding to use them and provide close monitoring when they feel a patient needs them. NSAID Side Effects Several studies that have been done over the years that involve NSAID use for low back pain have found that NSAIDs do work well relieving this type of pain. Unfortunately, many of these studies also mention a fairly high rate of side effects. Because of this, patients are usually warned that they should take the NSAIDs at the lowest possible dose that works for them and not longer than for two or three weeks, depending on what their doctor recommends. For the best possible effect, NSAIDs should be taken regularly during this period though, rather than just now and then. This allows the medication to build up in the blood, rather than build up and drop. Studies that Examined NSAIDs and Their Effectiveness Researchers found 65 studies that examined how effective NSAIDs were and how common side effects were. All of the studies combined provided a total of 11,237 patients/ subjects who were studied. The quality of the studies varied according to what type of study it was. This means, were the studies randomized, which pits the study drug against a placebo (sugar pills), double-blinded, which means neither the patients nor the researchers know which medication is being taken, large or small, short or long, and so on. There were several studies that examined how well NSAIDs work. These included 11 that compared NSAIDs with placebos in treating acute lower back pain, four comparing NSAIDs with placebos for chronic lower back pain, six that compared NSAIDs with acetaminophen for both acute and chronic lower back pain, and nine comparing NSAIDs Compliments of: Spine University

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Spine University's Guide to Low Back Pain and NSAIDs

with other medications such as opioids (narcotics) and muscle relaxants. Finally, there were four studies that compared the use of NSAIDs with non-drug treatments, such as spinal manipulation, physiotherapy, and bed rest. There were also several trials (33) comparing the different types of NSAIDs and their effects on back pain. The Results So, after reading all the studies and interpreting their results, what was the final outcome? The finding may have been surprising to some researchers, but the results showed that there really wasn't much of a difference between the different NSAIDs in providing relief over acetaminophen/ paracetamol for acute lower back pain. The researchers did note that acetaminophen does have fewer side effects than the traditional NSAIDs.

So, the findings mean what? Using the study findings, the researchers have learned that there is not much difference between the effectiveness of NSAIDs for acute lower back pain, although the rate of side effects can be different. Knowing that there is little difference between the medications but also understanding that patients react differently to different medications, this means that there may be some trial and error to find the most effective medication for each individual. It also means that while one medication may cause side effects, another may not, especially if the doctor chooses to use a medication from the COX-2 inhibitor category.

There was a difference between the NSAIDs and placebo, however. NSAIDs did relieve more pain, but on the other side, they also caused more side effects. Where there was a strong finding was with comparing the different NSAIDs when including the COX-2 inhibitors, like celecoxib. The overall finding was that although there wasn't much of a difference between the medications in terms of relieving acute lower back pain, there were significantly fewer side effects with the COX-2 inhibitors than with the traditional NSAIDs. This finding didn't follow with patients who had sciatica though. For them, there was no difference between NSAIDs and placebos for pain relief.

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Spine University's Guide to Low Back Pain and NSAIDs

Notes

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