A recent research suggests that the therapies that are often used to alleviate pain in the lower back, which the Centers for Disease Control and Prevention (CDC) identifies as the most prevalent form of pain, may actually cause the pain to persist for a longer period of time.
According to the findings of the research, the use of painkilling steroids and nonsteroidal anti-inflammatory medicines, such as ibuprofen, over an extended period of time may really transform an acute disease into a chronic one.
However, this study did not use a clinical trial. Instead, it consisted of observing patients, doing research on animals, and conducting an analysis of patient data contained in a vast database.
Dr. Thomas Buchheit, who heads up the group at Duke that focuses on regenerative pain medicines, had a different point of view.
People who suffer from back pain should begin their treatment with non-drug therapies including exercise, physical therapy, heat, or massage, as recommended by the guidelines established by professional medical associations. It turns out that such methods are just as effective as medications that decrease pain, but they don’t have the same side effects.
The recommendations recommend that patients try nonsteroidal anti-inflammatory medicines like ibuprofen if the discomfort continues for more than a few days. (Because it does not inhibit inflammation, acetaminophen cannot be considered an anti-inflammatory medication.)
However, the research that was published on Wednesday in the journal Science Translational Medicine contained a caution that such pharmacological treatment guidance might lead to chronic pain, which would reduce an individual’s quality of life.
The investigation started when scientists at McGill University started looking for molecular markers in patients’ blood that would indicate which patients’ pain would go away relatively soon and other patients’ pain would last for a longer period of time.
The research team obtained blood samples from 98 participants at the time they initially reported having back pain and again three months later after the discomfort had been present for them.
Those patients who reported that their pain had subsided showed a quick and severe inflammatory response when the pain was severe. The inflammatory indicators showed a subsequent downward trend over the subsequent three months. Those individuals whose discomfort did not go away had less of an inflammatory response.
The researchers kept on their investigation into the matter. They looked at persons who suffered from a particular kind of discomfort called TMJ, which stands for temporomandibular joint problems and causes pain in the jaw. Once again, those who made a full recovery had swift and severe inflammatory reactions.
The researchers also tested their theory on mice, either by applying pressure to the animals’ sciatic nerves, which caused them to experience pain in their backs and legs, or by injecting an irritant directly into the nerves. The persistent discomfort was caused by the blocking of the animals’ immunological response with the steroid dexamethasone, which is often administered to patients suffering from back pain.
The group then questioned whether or not chronic pain was caused by the suppression of pain or the suppression of inflammation. They did this by administering the anti-inflammatory drug diclofenac to a few of the mice. Gabapentin, morphine, or lidocaine are examples of additional analgesic, or pain-relieving, medicines that were given to some of the mice.
Because of these findings, the researchers posed the following question: Were patients who used nonsteroidal anti-inflammatory drugs, such as ibuprofen, or steroids, such as dexamethasone, to alleviate their back pain also more prone to develop chronic pain?
The researchers looked at information that was stored in a database known as the UK Biobank. This database had information on the medical conditions and drug usage of half a million people. They examined 2,163 patients who were experiencing acute back pain, of whom 461 went on to have chronic back pain. According to the findings of the study, those who used nonsteroidal anti-inflammatory medicines had a roughly twofold increased risk of getting chronic back pain compared to those who took other treatments or none at all.
Despite the fact that they are not very effective, nonsteroidal anti-inflammatory drugs continue to be a popular treatment option. According to the findings of a meta-analysis of randomised clinical studies, these medications provide essentially no advantage over placebos in terms of decreasing low back pain.
According to Dr. Atlas, the use of nonsteroidal anti-inflammatories for a short period of time is probably not harmful. However, he goes on to say that the new study, while not proving that long term use is harmful, “at least gives a biological mechanism that says short term use is not the same as long term.”
As contradictory as it may seem, Dr. James N. Weinstein, senior vice president of health at Microsoft, desires that individuals would reconsider their natural urge to grab for the ibuprofen tablets and instead choose to exercise when they experience pain.
According to Dr. Weinstein, who was not involved in the current research but served as the editor in chief of the medical magazine Spine for the last 28 years, he goes for a run whenever his back is bothering him. That in fact makes things much better.