Back pain is a common, recurrent and potentially debilitating condition. It causes impaired function and frustration for millions of people. In fact, low back pain is one of the most common reasons people go to the doctor, and it causes more than 2.5 million visits to U.S. emergency departments annually. As an emergency physician at Montefiore Health System, I see several patients with low back pain during every shift in the ED. For physicians, low back pain is a humbling condition because it seems simple to treat but, in fact, there are no great medications for it.
For most patients, low back pain gets better after several days to several weeks. For some, it will recur again at a later date. The goal for patients and physicians is to hasten improvement of the acute attack and prevent recurrence later. Sometimes, patients progress from acute low back pain to chronic low back pain, a horrible disease characterized by low back pain on more days than not. The goal for emergency physicians when we see patients who present with new-onset low back pain is to prevent this transition to chronic low back pain.
[See: 11 Ways to Cope With Back Pain.]
When I see a patient with low back pain in my ED, I often prescribe medication. In fact, the standard of care is to prescribe one or several medications, such as non-steroidal anti-inflammatory drugs — NSAIDs, like Motrin (ibuprofen) or Aleve (naproxen) — skeletal muscle relaxants like Flexeril (cyclobenzaprine) or Zanaflex (tizanidine), or opioids like Percocet (oxycodone/acetaminophen). Many low back patients in EDs across the country receive combinations of these medications to treat their pain. However, over the course of 13 years, my research, and the research of many other physicians, has shown that very few medications have been proven to be effective for alleviating back pain.
In my most recent paper, published in the Annals of Emergency Medicine, I found that combining two frequently prescribed medications — naproxen (Aleve) with diazepam (Valium) — did not improve functional outcomes or pain, compared with a naproxen and placebo combination. One week and three months after the ED visit, these low back patients felt exactly the same, regardless of whether they got diazepam or placebo. This result was surprising because physicians frequently prescribe diazepam for low back patients, thinking it will relax the muscles of the back and afford these patients some relief. This study builds on my body of work investigating the efficacy of various pharmaceutical treatments for low back pain. In our ED, we have done a series of low back pain studies to determine which treatments should be used for low back pain patients, and which treatments just cause side effects without actually helping the patients’ symptoms. It is humbling to see that in all our clinical trials, none of the medications are the silver bullet that we, and our patients, are hoping for.
[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]
My studies, and many others, have shown that few patients gain relief from medication alone. Many patients will get better by themselves. But it doesn’t appear that medications help patients heal completely — the best medication for low back pain seems to be one of the NSAIDs, but even these only help about 1 patient out of 10. New guidelines issued by the American College of Physicians reflect this thinking. Rather than use medication to treat low back pain, patients should seek out complementary approaches such as massage, acupuncture and yoga. This dovetails with my clinical experience, as well — the happiest back pain patients I know are the ones who have found relief with yoga, massage or stretching. It’s also true that there is no “one size fits all” solution; for many patients, the best approach to easing back pain is a discussion with your doctor about appropriate holistic approaches to care.
[See: 10 Reasons You Should Try Self-Massage.]
Medications are the go-to solution for many people with pain, but we know that these can cause short-term side effects, such as nausea, stomach ulcers, drowsiness and dizziness. Health care providers know to prescribe these medications cautiously. Low back pain patients, too, should understand the limitations of medications when it comes to their suffering — there are no magic cures. We need to make more back pain sufferers aware that reaching for a yoga mat should be one of the first things that comes to mind, rather than reaching for medicine.
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Seeking Relief for Back Pain? Reach for a Yoga Mat, Not Meds originally appeared on usnews.com
