NSAID Drug Therapy Fails to Ease Back Pain

FRIDAY Nov. 9, 2007 -- Two widely used treatments for acute low back pain -- nonsteroidal anti-inflammatory drugs (NSAIDs) and spinal manipulation -- did not help patients in a carefully controlled study, Australian researchers report.

That's not especially surprising, American specialists said, because the evidence for their effectiveness has never been overwhelming. In fact, new recommendations for treating lower back pain take the lack of effectiveness of these treatments into account.

However, this is one of very few studies to provide solid documentation of what happens -- or doesn't -- with the treatments, the experts said.

"They just don't work better than placebo control," said Dr. Todd J. Albert, professor of orthopedic surgery and neurosurgery at Jefferson Medical College, who was not involved in the research. "But they are two common things that physicians do all the time. Patients come to a hospital feeling entitled to a treatment, and doctors feel they have to treat," he said.

The Australian study, done at the University of Sydney, included 240 people who had been treated with acetaminophen for low back pain without getting major relief. They were divided into four groups -- one getting the NSAID diclofenac (sold as Voltaren) at 100 milligrams per day and manipulative therapy, another getting the drug and a fake manipulative therapy, a third getting real manipulative therapy and a placebo drug, and the fourth getting a placebo drug and the fake manipulative therapy.

"Neither diclofenac nor spinal manipulative therapy gave clinically useful effects on the primary outcome of time to recovery," the researchers report in the Nov. 10 issue of The Lancet.

New guidelines just issued by the American College of Physicians and the American Pain Society already advise against general use of the two therapies, noted Dr. Daniel Mazanec, associate director of the Cleveland Clinic Center for Spinal Health.

"For this group of patients, with acute nonspecific low back pain with an average duration of nine days, the guidelines recommend the importance of staying active and [taking] relatively simple painkillers such as acetaminophen," Mazanec said.

Still, "this is the first study in a well-characterized group of patients to support the guidelines," he said.

The potential side effects of NSAIDs make avoiding them advisable if possible, Albert said. But one or another of them may still be used in individual cases, since different people may get some relief from one NSAID but not another, he said.

"There is individuality to response," he said.

Other NSAIDs include aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve).

While diclofenac did not speed the progression to recovery from pain, "that doesn't mean it should not be used, because it may make patients more comfortable along the way," Albert said.

Side effects of NSAID treatment in the study included gastrointestinal disturbances, dizziness and heart palpitations. However, the incidence of such side effects was about the same in the group getting the placebo drug treatment, the researchers noted.

More information

There's more on back pain at the U.S. National Library of Medicine.

Posted: November 2007


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