Conventional medications can prolong back pain when overused, the study said

Over-the-counter painkillers at a pharmacy in New York, July 13, 2015. (Hiroko Masuike / The New York Times).

According to the Centers for Disease Control and Prevention, the treatment used to alleviate lower back pain is the most common form of the disease, according to a new study.

Regular use of painkillers and non-steroidal anti-inflammatory drugs, such as ibuprofen, can actually make the condition chronic, the study said.

Some medical experts have called for caution in interpreting the results too broadly. If the study did not use the gold standard for medical research in this clinical trial, then people with low back pain would follow up to see who had a chronic illness, randomly assigned to take a non-steroidal anti-inflammatory drug or placebo. Instead, it included patient surveys, animal studies, and analysis of patients in a large database.

Subscribe to The Morning Newsletter from the New York Times

“It’s interesting, but it requires further research,” the doctor said. Steven J. Atlas, director of research and quality improvement based on primary care practice at Massachusetts General Hospital.

Dr. Bruce M., a disease specialist at Dartmouth Hitchcock Medical Center in New Hampshire. Vruman agreed, but called the study “impressive in its scale” and said it could “force a reconsideration of how it works” if the results are preserved in a clinical trial. we treat serious illness. ”

Dr. Thomas Buchheit, director of Duke’s Rehabilitation Program, had a different view.

“People overuse the term ‘paradigm shift,’ but it’s a complete paradigm shift,” Buchheit said. “There’s an unspoken rule: if he’s sick, take anti-inflammatory drugs, and if he’s still sick, put steroids on him.” But, he said, research has shown that “we need to think about healing, not suppressing inflammation.”

The guidelines of the professional medical community say that people with low back pain should start with non-drug treatment such as exercise, physical therapy, heat or massage. These measures are as effective as painkillers and do not have the same side effects.

If the disease persists, people can use non-steroidal anti-inflammatory drugs such as ibuprofen. (Acetaminophen is not anti-inflammatory because it does not stop inflammation.)

But a study published in the journal Science Translational Medicine on Wednesday warned that such drug treatment recommendations could contribute to a chronic illness that reduces a person’s quality of life.

The study began when researchers at McGill University began looking for molecular markers in the blood that could predict which patients would recover faster and which would continue.

Blood samples were taken from 98 people when they first reported low back pain and three months after the onset of the disease.

“What we saw was not exactly what we expected,” the doctor said. Luda Diatchenko is the study’s lead researcher and a professor at McGill who specializes in human disease genetics.

Those who claimed to be ill became inflamed quickly and severely when the disease became severe. Then the markers of inflammation decreased over the next three months. When the disease stopped, there was no such inflammatory reaction.

“Nothing happened to people with chronic diseases,” Diatchenko said.

“It was a big difference,” he added.

The researchers continued their research. They studied people with another type of disease that causes jaw pain, TMJ or temporomandibular joints. Once again, those who recovered experienced rapid and severe inflammatory reactions.

The researchers also replicated the findings in mice by injecting nerve impulses or injections into animals to relieve pain in their backs and legs. When they suppressed the animal’s immune response with dexamethasone, a steroid steroid commonly used to treat back pain, the disease became chronic.

The group then asked if the chronic pain was caused by pain relief or inflammation relief. Thus, they gave diclofenac to some mice on an anti-inflammatory prescription. Other mice received one of three different painkillers or painkillers — gabapentin, morphine, and lidocaine.

Only with diclofenac did the disease become chronic.

These results led them to ask the question: Can patients who take nonsteroidal anti-inflammatory drugs such as ibuprofen or steroids such as dexamethasone to reduce back pain develop chronic pain?

Researchers turned to data from the British Biobank, which contained information on the health status and drug use of half a million patients. They studied 2,163 people with acute low back pain, 461 of whom had a chronic illness. Researchers found that those who took nonsteroidal anti-inflammatory drugs were almost twice as likely to develop chronic low back pain as those who did not take other drugs or medications.

Diatchenko believes his findings have nothing to do with opioid dependence. In fact, he said, “To prevent opium, clinics have started prescribing more non-steroidal anti-inflammatory drugs.”

“We need to think more about how to treat our patients,” he said.

The trend of using nonsteroidal anti-inflammatory drugs continues despite their ineffectiveness. Analysis of randomized clinical trials has shown that these drugs have almost no benefit in reducing back pain compared to placebo.

Atlas says short-term use of nonsteroidal anti-inflammatory drugs is not harmful, but a new study adds that “at least provides a biological mechanism for short-term use,” without proving that long-term use is harmful. was long-term. “

Dr. James N. Weinstein, Microsoft’s senior vice president of health, wants people to reconsider their instincts to access ibuprofen pills and exercise instead.

Weinstein, who was editor-in-chief of the medical journal Spine for 28 years and did not participate in the new study, said he would go out to run when he had back pain. It actually makes it better.

“I love it,” he said of the study, “I know it’s true.”

© 2022 The New York Times Company

Leave a Comment

Your email address will not be published.