NSAIDs and Back Pain

NSAIDs

NSAIDs are non steroidal anti-inflammatories. These include Ibuprofen and Nurofen

For some many years now we have been telling patients that using NSAIDs, such as Ibuprofen, delays the recovery of musculo-skeletal problems. The rationale is that inflammation is part of the normal healing process and NSAIDs slow or even stop the process. They are not painkillers and the pain only stops because the inflammatory process has been stopped. This is why the pain returns when patients stop taking the NSAIDs.

The paper below is now supporting this and even suggesting that this may be one of the reasons why there are so many patients with chronic pain. The news last week was all about how many chronic patients there are now and how they are having difficulty accessing the right services to help them overcome the problem.

I wonder how long it will take for GPs to stop prescribing NSAIDs and for the general public to realise that taking Nurofen, Ibuprofen etc is not the answer?

Less than 1% of people with low back pain have a potentially serious problem, but an experienced and knowledgeable clinician who can preform a detailed clinical examination and provide the right treatment for a given diagnosis, is the way forward. It is the role of Physiotherapists with specialist post graduate training in Musculo-skeletal Medicine who should be seeing these patients - and prefereably within the first 6 days. Extended waiting lists equally don’t help, but then as back pain is seldom a life threating condition, it would seem that they can wait!

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Ralph Ellis

May 13, 2022

A new study questions the conventional wisdom of using steroids and anti-inflammatory drugs like ibuprofen to treat low back pain if exercise and other non-drug therapies don't work right away.

Those medications offer relief from acute pain but may actually increase a person's chances of developing chronic pain, said the study published in Science Translational Medicine. The study indicates that inflammation is a normal part of recovering from a painful injury and that inhibiting inflammation may result in more-difficult-to-treat chronic pain.

"For many decades it's been standard medical practice to treat pain with anti-inflammatory drugs," Jeffrey Mogil, a psychology professor at McGill University, said in a school news release. "But we found that this short-term fix could lead to longer-term problems." 

Researchers looked at low back pain because it's so common, with 25% of U.S. adults saying they had low back pain in the previous three months, according to the CDC. Acute back pain is defined as lasting less than four weeks while chronic back pain lasts more than 12 weeks.

By examining blood samples, researchers discovered that people whose low back pain was resolved had high inflammation driven by neutrophils, a type of white blood cell that helps the body fight infection, the study said.

"Neutrophils dominate the early stages of inflammation and set the stage for repair of tissue damage. Inflammation occurs for a reason, and it looks like it's dangerous to interfere with it," Mogil said in the news release.

The research team found that blocking neutrophils in mice prolonged pain in the animals up to 10-fold. Pain also was prolonged when the mice were given anti-inflammatory drugs and steroids, the news release says.

McGill University said other studies support the findings. The school cited an analysis of 500,000 people in the United Kingdom. The analysis found that those taking anti-inflammatory drugs for pain were more likely to have pain 2 to 10 years later.

While saying the study suggests it's time to reconsider how pain is treated, researchers called for clinical trials on humans, not just observations of people with low back pain.

Experts warned about accepting the results without further investigation.

"It's intriguing but requires further study," Steven J. Atlas, MD, director of the Primary Care Research & Quality Improvement Network at Massachusetts General Hospital, told The New York Times.

Sources:

Science Translational Medicine: "Acute inflammatory response via neutrophil activation protects against the development of chronic pain."

McGill University: "Discovery reveals blocking inflammation may lead to chronic pain."

CDC: "Acute Low Back Pain."

The New York Times: "Common Medications Can Prolong Back Pain When Overused, Study Says."

Credit:Lead image: Getty Images

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This news article was written and produced by staff at WebMD Health and is intended for a consumer audience. Questions or comments? Email newstip@webmd.net.

Cite this: Using Anti-Inflammatory Drugs May Prolong Back Pain - Medscape - May 13, 2022.