A recent report by the ABC News was posted on 3rd Feb this year titled:
ABC News: Anti-inflammatories ‘no better than placebo’ for back pain.
This report presented the findings of an Australia study on anti-inflammatory medication acute and chronic low back & neck pain (Machado et al., 2017).
The study was a systematic review of 35 randomised placebo controlled trials, where the evaluated the efficacy of anti-inflammatory medication versus placebo medication for spinal pain.
The ABC News then posted the key findings of the study as follows:
Key findings:
- Anti-inflammatory drugs not clinically better for back pain than placebo
- Risk of gastrointestinal side effects
- Need for find better ways to treat pain
Does this mean that anti-inflammatory medication is not effective for back pain?
No!
And this is a perfect example of the problems of research studies.
It is also a classic example of how information is poorly presented to the public by the media.
The study in question noted that only 1 in 6 people given the medication got significant relief, therefore concluding that is was no more effective than a placebo and that other forms of therapy need to be further researched for back pain.
The problem with this study and much of the research out there on back pain is the failure to recognise that back pain is a symptom not a diagnosis.
The key is that if only the patients that had inflammation as a cause of their lower back pain were correctly identified, and only those patients were given the anti-inflammatory medication then the success rate would be dramatically higher.
A perfect analogy that Ron Donelson (a diplomat in the McKenzie Method and orthopaedic spinal surgeon) makes in his book (Rapidly Reversible Low Back Pain) is that of chest pain. He uses the example of everyone with chest pain being given GTN (glyceryl trinitrate). If this administered to every person with chest pain the success rate of the drug would be very low and considered to be ineffective. Those with referred pain from the thoracic spine, and a variety of other causes of chest pain would not respond. But if only those who had angina were given the medication, the success rate of the drug would increase dramatically, and as we know GTN is extremely effective for those with chest pain caused by angina.
How do you identify someone that does likely have low back pain as a significant contributor to their symptoms?
Unfortunately, the research studies does not correctly subgroup patients with low back pain. And correct subgrouping with low back pain is the key to improved outcomes, and ensuring that each patient gets the right individualised treatment.
Clinical clues for relevant inflammation for the current low back symptoms:
- Pain is truly constant
(no part of the day where the person is pain free, even for 10 mins)
- Back pain is worse at night when lying in bed
(this is due to the accumulation of chemicals from static positions like lying)
- Back pain worsens with any static position like sitting, standing or lying, but are improved somewhat with gentle movement of any kind
- Back pain and stiffness is significantly worse first thing in the morning, often for more than 30 mins
(this is again due to the accumulation of chemicals from static positions)
- Repeated movements of the spine in any direction do not rapidly and lastingly relieve the pain, even when the range of motion clearly improves
And not surprisingly when patients with these characteristics are given the anti-inflammatory medication the clear majority get significant relief in my clinical experience. This is particularly likely if they have been put through a thorough physical exam by a highly trained professional and not had any change in symptoms with treatment.
Come and see our McKenzie Method Specialist Physiotherapist Joel Laing at Absolute Health & Performance and get an assessment that will determine the source of your specific back pain and the solution for it.
References:
Machado GC, Maher CG, Ferreira PH et al. Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis. Annals of the Rheumatic Diseases 2017. doi: 10.1136/annrheumdis-2016-210597
“Back Pain: This Is What Anti-Inflammatory Drugs Can Do To Your Body”. Zee News. N.p., 2017. Web. 9 Feb. 2017.
“Anti-Inflammatories ‘No Better Than Placebo’ For Back Pain”. ABC News. N.p., 2017. Web. 9 Feb. 2017.
Donelson, Ronald and Ronald Donelson. Rapidly Reversible Low Back Pain. 1st ed. Hanover, New Hamp.: SelfCare First, LLC, 2007. Print.
