An estimated 50% of Americans will experience low back pain this year. Approximately 80% will experience low back pain at some point in their lifetime.
Here is some good news. An estimated 90% of people with back pain will recover well within a few weeks or months. However, the other 10% will go on to experience chronic disabling back pain resistant to treatment.
Identifying factors that may lead to chronic pain is a complex matter. Some believe that controlling the initial intensity of pain is the key. However, research does not strongly support this idea. Efforts to control pain with medication may be more harmful than helpful. This article explains why a more active approach to managing pain is a better option.
Opioids, Low Back Pain, and Depression
Recent practice guidelines published in the European Spine Journal recommend against the use of imaging (MRI or CT scans), injection, anti-inflammatory medications (ibuprofen, etc), and opioids. These same guidelines recommend using patient education, exercise, and manual therapy as first treatments for low back pain or sciatica. Contrary to popular belief, research does not support the use of opioids for short-term pain relief for back pain or sciatica.
In the United States, there is a strong association between depression, low back pain, and being prescribed opioid pain medication. Individuals with low back pain and a history of depression are more likely to be prescribed opioid medication. Also, the dosage these people are prescribed is 2x as high per year compared to those who have no history of depression.
These facts suggest that individuals with a history of depression are more likely to develop addiction to these powerful medications.
Muscle Relaxants and Low Back Pain
Muscle relaxants may offer a safer pharmacological option to manage back pain compared to opioids. Research suggests a potential short-term benefit to using muscle relaxants when pain is severe. However, evidence is lacking to support the use of these medications for patients with low back pain lasting greater than 3 months. Adverse reactions to these medications are usually minimal and similar to those experienced with a placebo.
Anti-Inflammatory Medications
The best available evidence suggests a very small and non-significant benefit to using non-steroidal inflammatory medications for back pain and sciatica. The benefits of using these medications for a new episode of back pain are questionable and the side effects can be severe.
The most serious side effects include ulcers, cardiovascular events (heart attack or stroke), and kidney failure. Use short-term doses to minimize your risk.
Consider An Active Approach to Treating Your Back Pain
Physical therapists cannot prescribe medication and cannot counsel anyone who is currently taking prescription medication. However, we do hope that anyone taking prescription medication for low back pain understands the risks, especially with using opioids. Please carefully discuss these risks with your physician.
Living an active medication-free life, with little or no pain, is possible and always a reasonable goal. Contact your physical therapist and schedule an appointment for an initial evaluation so you can learn how.
