Health

For acute lower back pain, these are the best medications, new study finds


Lower back pain is one of the most common ailments, with four out of five people experiencing it at some point in their lives, according to the website for the Cleveland Clinic in Cleveland, Ohio.

For immediate relief after a back injury, over-the-counter (OTC) pain relievers are usually the go-to.

Yet with many different medications lining drugstore shelves, people are often confused about the right options to choose.

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The three best options for acute lower back pain are NSAIDs, NSAIDs with paracetamol, and myorelaxants, according to a recent study published in the Journal of Orthopaedic Research.

Lower back pain is one of the most common ailments, with four out of five people experiencing it at some point in their lives. (iStock)

NSAIDs — which include aspirin (Bayer), ibuprofen (Advil, Motrin) and naproxen (Aleve) — are nonsteroidal anti-inflammatory drugs that alleviate pain, reduce inflammation and bring down fevers. 

NSAIDs are available over the counter up to a certain strength. 

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“NSAIDs are pretty much the second-strongest anti-inflammatory that we have, other than steroids,” Dr. Randa Jaafar, a pain management physician in New York City, told Online News 72h Digital. 

(She was not involved in the study.)

Tylenol is a popular over-the-counter brand of acetaminophen, which relieves pain and reduces fever.

Tylenol is a popular over-the-counter brand of acetaminophen, which relieves pain and reduces fever. (iStock)

Paracetamol is acetaminophen (Tylenol), which relieves pain and reduces fever. 

Tylenol is available without a prescription in all strengths. This over-the-counter medication was not effective in alleviating lower back pain on its own, the study found. It worked better when paired with an NSAID.

“A lot of people think that Motrin and Tylenol do the same thing, but they can actually be taken together,” Dr. Jafaar said. (The wisest course of action is to check with a doctor first about proper amounts for your individual case.)

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The third type of medication named in the study, myorelaxants, are muscle relaxers, which require a doctor’s prescription. 

Myorelaxants work by altering the nervous system to reduce muscle spasms.

The study — titled “Nonopioid pharmacological management of acute low back pain: A level I of evidence systematic review” — analyzed the findings of 18 randomized controlled trials (RCTs) that investigated the effectiveness of the three types of medications.

A recent study found that the three best options for acute lower back pain are NSAIDs, NSAIDs with paracetamol and myorelaxants.

A recent study found that the three best options for acute lower back pain are NSAIDs, NSAIDs with paracetamol and myorelaxants. (iStock)

The 18 trials included data from 3,478 patients who had experienced acute lower back pain. 

More research is needed to determine the three drugs’ effect on the recurrence of lower back pain, the study authors wrote.

Studies involving opioid pain relievers were not included in the review.

The study was conducted by a group of orthopedic doctors, most of them from RWTH University Hospital in Aachen, Germany.

Importantly, the study applied only to acute back pain — not chronic.

Alternatives to opioids

There’s been a growing emphasis on non-opioid pain medications such as the ones included in this study, Jafaar told Online News 72h Digital.

“These three medications attack pain from all different angles,” she said. “They are definitely a better alternative to opioids.”

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Opioids — which include oxycodone (OxyContin), hydrocodone (Vicodin) and morphine, among others — “travel through your blood and attach to opioid receptors in your brain cells,” which then release signals that “muffle your perception of pain and boost your feelings of pleasure,” according to the Mayo Clinic’s website.

Lower back pain is characterized as acute if symptoms are experienced for fewer than 12 weeks.

In addition to being highly addictive for some patients, opioids also carry a small risk of opioid-induced hyperalgesia (OIH), which is when the medication creates a higher sensitivity to pain over time, Jafaar explained.

In 2020, almost 75% of all drug overdose deaths involved an opioid medication, the Centers for Disease Control and Prevention (CDC) notes on its website.

Acute versus chronic lower back pain

Lower back pain is characterized as acute if symptoms are experienced for fewer than 12 weeks. 

The new study was conducted by a group of orthopedic doctors, most of them from RWTH University Hospital in Aachen, Germany. Also, the study applied only to acute back pain — not chronic.

The new study was conducted by a group of orthopedic doctors, most of them from RWTH University Hospital in Aachen, Germany. Also, the study applied only to acute back pain — not chronic. (iStock)

Pain is considered chronic if it lasts for three months or more.

“Chronic back pain usually means there’s some scar tissue, so it’s usually not so much related to inflammation, but there’s still an inflammatory component,” Dr. Jafaar said.

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When treating any type of lower back pain, Dr. Jafaar typically starts with pain-relieving medications and physical therapy, then moves to epidurals if necessary.

“If the pain is gone at that point, then it can be classified as acute, but if it continues past that point, then I may move on to more aggressive treatments, like spinal cord stimulation,” she said.

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If a patient is taking a combination of medications for more than three months, he or she should see a doctor and explore a different course of action, said Jafaar.



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