- New research suggests that a combination of non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and muscle relaxants is the best first line of defense against certain types of lower back pain.
- The systematic review started with 12,484 studies before whittling it down to 18.
- Experts say that this method of treating lower back pain is a key part of a wide set of possible treatments.
Lower back pain is a common ailment that can drive people to take swift and sometimes invasive measures, like having surgery or taking opioids, in search of relief.
Now new research has found that there may be an ideal mix of non-opioid medication that can effectively treat lower back pain in many patients.
The new meta-analysis
The researchers found that a combination of non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and muscle relaxants (myorelaxants) have proven effective for treating non-specific lower back pain.
- The three methods of treatment in combination worked better than others in isolation or when a placebo was used.
- The researchers suggest that further investigation needs to be done on effective treatments for back pain that continues to resurface
- Acetaminophen alone was deemed to be ineffective in reducing pain
Dr. Jerrold Kaplan, a physiatrist and medical director at Gaylord Specialty Healthcare who focuses on musculoskeletal medicine and pain consultation, said this research is a good tool for clinicians as they talk about pain management with patients.
“This type of information is critically important to them so that they can discuss it with their patients, and reassure them that the literature does support using non-opioid options to treat low back pain. And I think that will go a long way in helping us also decrease the number of opioids prescribed and [not] making the opioid crisis even worse.”
While the research, as it’s an overview, did not name specific medications, some general examples of muscle relaxants that can be prescribed include baclofen and tizanidine. Common NSAIDs include ibuprofen and naproxen. Acetaminophen is often sold under the brand name Tylenol.
The study’s focus is on non-specific lower back pain rather than back pain that can be traced back to a particular source. The researchers found that the use of NSAIDs in combination with these other medications brought pain down within a week.
The experts who spoke to Healthline said in addition to these OTC and non-opioid medications there are non-invasive options that can help people with back pain. These options include the use of heat, acupuncture, and massage, which were also discussed in the study.
Dr. Dung Trinh, a former clinical assistant professor at the University of California-Irvine and current chief medical officer of The Healthy Brain Clinic, says that it’s important to recognize that lower back pain can come from a variety of sources and not just, as the study points out, from more obvious trauma.
“Lower back pain does not need to be a diagnosis of just being old,” Trinh said. “Lower back pain is the combination of accumulation of lifestyles, that includes nutrition, that includes posture that includes, you know, what kind of work you did all your life that may potentially put extra strain to your back.”
While the study pointed to the efficacy of different medications for treating recurring lower back pain as the next step for research, those in the field say that the broadening of treatment options when it comes to lower back pain is key.
Dr. Gerry Stanley, a former family doctor is the Chief Medical Officer with Harvard MedTech, which focuses on using digital technology to help with pain management and is based in Nevada. He says that this research is a good confirmation of valuable non-opioid treatments for lower back pain.
“We know that these drugs are well established,” Stanley says, “They’re a safe first-line agent, they have a very manageable and noticeable side effect profile, so it’s a great entry point in dealing with injuries, especially low back pain. The problem is, if we’re not hitting a home run every time, if we’re hitting singles and doubles, what do we do next? How do we move that needle to get that patient back to whole or get that patient back to where they feel normal?”
In Kaplan’s case, he would like to see more research done into how these medications work in combination over a long period of time.
“I agree with a general conclusion [of the study], but I think it’s also important to look at the duration of treatment and get into a little bit more specific details for guidelines with that. NSAIDs are good medications, but longer term use of them also can have potential side effects.”