If you’re experiencing low back pain, you’re not alone. This common condition can cause discomfort, limit your mobility, and impact your overall quality of life. Medication can be a convenient pain relief treatment for low back pain symptoms. However, it’s important to consider all available options.
Chiropractors, who do not prescribe medication, can still play a valuable role in your care. They focus on non-invasive methods such as chiropractic adjustments and manual therapy. Evidence-based chiropractors, however, focus on long-term results and self-management. As such, we often only provide exercise therapy as well as lifestyle interventions to help you find lasting back pain relief. While chiropractors cannot prescribe medication, we can share the latest research with you. This helps you make an informed decision about your treatment.
In this blog post, we will explore four commonly prescribed medications for low back pain. They are paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and opioids. By considering their effectiveness and potential effects, you can make a well-informed decision about your pain management.
When it comes to managing mild to moderate pain, including lower back pain, you may think of paracetamol (also known as acetaminophen). A widely used over-the-counter medication, it works by blocking pain signals in your brain, providing you with relief from discomfort. Despite its popularity, the latest research does not support that paracetamol is effective against lower back aches and soreness.
The Lancet published a series of three papers in 2018 that remains the most authoritative guide to low back pain to date. The researchers comprehensively reviewed the evidence on the global impact and management of low back pain and found that paracetamol is not as effective as previously thought in providing pain relief. Instead of relying on medication, the guideline emphasised the importance of using non-pharmacological treatments, such as exercise and education, as the primary approaches.
The National Institute for Health and Care Excellence (NICE) in the United Kingdom also updated its guidelines in 2016 to advise AGAINST the use of paracetamol as a stand-alone treatment for low back pain. This recommendation remained the same when NICE updated their guidelines again in 2020. The NICE highlighted exercise programs and psychological interventions as more effective treatment options for back pain.
Non-steroidal anti-inflammatory drugs (NSAIDs) are another medication option for your low back pain. NSAIDs, like ibuprofen and naproxen, not only relieve pain but also have anti-inflammatory properties, making them suitable for cases involving inflammation. By inhibiting the production of certain chemicals that contribute to pain and inflammation, NSAIDs help alleviate your symptoms. You can find some NSAIDs over-the-counter, while others may require a prescription. Keep in mind that long-term use of NSAIDs may have side effects, particularly gastrointestinal issues, so it’s essential to use them cautiously and consult your healthcare professional if needed.
A major study investigating 32 trials with 5356 participants found that NSAID performed slightly better than placebo for the treatment of back pain. However, the improvement was small and unlikely to be clinically meaningful. This means that although NSAIDs may provide some pain relief, the amount of relief is not going to help the patient. The most recent Cochrane review published in April 2023 echoed the same findings: NSAIDs can only help a little with back pain.
Despite the excessively underwhelming research supporting the use of NSAID, the American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) recommended NSAID as first-line treatment for low back pain. To the best of our knowledge, they are the only organisation in the world to list a pharmacological intervention as first-line treatment for lower back pain.
There are many exercises for lower back pain. While they may be painful to do at the start, an evidence-based chiropractor will be able to guide you through the rehabilitation process. Our trainer is doing an exercise called upside down turtle in the above video.
3. Muscle Relaxants
If you experience low back pain accompanied by muscle spasms or tension, your healthcare provider may prescribe muscle relaxants to you. They commonly use medications like cyclobenzaprine, methocarbamol, and baclofen to promote muscle relaxation by depressing your central nervous system. While these medications can provide you with pain relief, muscle relaxants are recommended for short-term use due to their sedating effects and potential for dependence.
As relaxants can cause drowsiness and impair coordination, do avoid activities that require alertness while taking them. Always follow your healthcare professional’s instructions and seek their advice if you have any concerns.
In Singapore, Anarex is widely prescribed as a muscle relaxant to help with muscle pain. Anarex is a medication that contains both paracetamol and orphenadrine. Despite its popularity, there is almost no studies done on it. In 1991, two doctors claimed that orphenadrine / paracetamol is superior to paracetamol alone despite admitting the lack of research. Another paper, published in 1983, reported that orphenadrine/paracetamol is significantly superior to placebo for myalgia nuchae. It is unclear why Anarex remains commonly prescribed even though there is an absence of research supporting its efficacy.
If you have severe back pain that does not respond to other medication, your doctors may recommend opioids. These potent pain relievers, including codeine, oxycodone, and hydrocodone. Opioids work by binding to opioid receptors in your brain and spinal cord. In doing so, they reduce pain signaling. However, opioids come with significant risks, such as dependence, addiction, and overdose. They are typically reserved for short-term use in carefully selected cases. Due to the ongoing opioid crisis, the use of opioids for chronic pain management is a topic of debate. If opioids are prescribed to you, it is crucial to be closely monitored by a healthcare professional.
In the United States, Purdue Pharma, the maker of OxyContin, has faced significant litigation. In 2020, the company reached a settlement agreement with the U.S. Department of Justice (DOJ), admitting to criminal charges related to its marketing practices. As part of the settlement, Purdue Pharma filed for bankruptcy and established a trust to compensate individuals and communities affected by the opioid crisis. Johnson & Johnson, through its subsidiary Janssen Pharmaceuticals, has been involved in opioid lawsuits. In 2021, the company reached a $230 million settlement with the state of New York, resolving claims related to its marketing practices. Johnson & Johnson has also faced legal action from other states and municipalities.
The opioid crisis is not limited to the United States. In Australia, the government launched the National Strategic Action Plan for Pain Management to improve pain management and reduce reliance on opioids. The government has also implemented real-time prescription monitoring systems to help prevent misuse and diversion of prescription opioids. Other changes include stricter criteria for prescribing opioids, reducing pack size, and promoting the use of alternative pain management strategies.
Finding a healthcare provider to provide person-centred care
Choosing the right medication for your low back pain requires collaboration with a healthcare professional. A person-centred provider will consider your specific condition, medical history, individual needs, as well as personal values and preferences. Remember that medication alone is rarely sufficient for long-term management of low back pain. Self-management strategies such as regular physical activity, back pain exercises, and lifestyle modifications often play a crucial role in improving outcomes.
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Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.
Our goal? To make our own services redundant to you.