Back pain? Here’s the therapies and medicines that work, and what doesn’t

Back pain: if you haven’t experienced it, you are among a small percentage of people across the world who have been very lucky. For those who have had an episode of back pain, it may have been a short-lived experience, but it can also turn into an ongoing nightmare. According to medical journal The Lancet, in 2018, low back pain has been one of the leading causes of ‘years lived with disability (YLD)’ since 1990 – not just here in Australia but internationally. It continues to be a global public health problem.

The world has faced an unprecedented time, a year of living through the pandemic of Covid-19, and adapting to the “new” normal. Unfortunately, many people are ignoring investigations and treatment for chronic medical conditions since the advent of Covid-19, often to their detriment. I saw a patient the other day whose brother died overseas because he did not seek urgent attention for chest pain for fear of contracting Covid-19 if he went to hospital.

Returning to back pain, why is it so difficult to manage? In part, the reason is related to the condition itself, and the fact many medicines are not beneficial. According to a study published in the Journal of Orthopaedic & Sports Physical Therapy in 2020, approximately 85-95 per cent of people presenting to general practitioners with back pain do not have a specific identifiable patho-anatomical origin for their pain. The pain may be caused by a number of structures in the back, creating the label of “non-specific low back pain”.

Most people with an acute back pain episode recover quickly, but up to 30 per cent will still have pain after one year. Preventing the acute pain from turning into a chronic problem is key in managing back pain.

Clinical guidelines have been developed to recommend suitable treatments for back pain. Guidelines change over time, however, depending on new research findings. For example, opioid medicines are now discouraged for managing back pain and chronic non-cancer pain, in light of the potential harms of opioids as they frequently do not outweigh the benefits.

So what do the current guidelines recommend? Recommendations for specific therapies differ between guidelines across countries but, in general, they recommend reassurance that most episodes settle quickly, trying non-pharmacological interventions first, and then using medicines if needed.

For acute back pain, the American College of Physicians (ACP) said this may include non-pharmacological interventions such as superficial heat (e.g. low-level continuous heat from a heat wrap) or manual therapy such as massage or acupuncture. For chronic back pain, the ACP added that tai chi, yoga, stress reduction techniques and cognitive behavioural therapy may be beneficial.

If pain medicines are needed, most guidelines now recommend non-steroidal anti-inflammatory drugs as first-line therapy, and an effective dose used for the shortest time possible. Newer mechanical therapies are being introduced in this area with good effectiveness for many people.

As an intermittent back pain sufferer myself, I perform a daily routine of weights, stretching and yoga exercises. I also have a weekly remedial massage and receive a very new therapy named MedKey, which is an electro-magnetic device applied to the areas of pain and spasm. Since following this regimen, my episodes of back pain have become very occasional and mild.

If you are suffering severe sciatica, where (typically) a disc is bulging in the lower spinal cord, pressing on the nerves, a microdiscectomy performed by a spinal neurosurgeon is a limited but highly effective procedure. Some medicines, such as anticonvulsants, are not recommended to manage back pain and sciatica.

I spoke to an expert in this area: Dr Stephanie Mathieson, research fellow at the Institute for Musculoskeletal Health, University of Sydney. She was part of a team that tested if the anticonvulsant pregabalin reduced pain in people with sciatica. This clinical trial was part of her PhD thesis and found that pregabalin worked no better than the placebo. So, it did not reduce back pain or leg pain any more than taking a sugar pill!

IMPORTANT LEGAL INFO This article is of a general nature and FYI only, because it doesn’t take into account your personal health requirements or existing medical conditions. That means it’s not personalised health advice and shouldn’t be relied upon as if it is. Before making a health-related decision, you should work out if the info is appropriate for your situation and get professional medical advice.