Non-opioid treatments for chronic, long term back pain

HARTFORD - “Oh my aching back” is a common saying for good reason.

In the United States, lower back pain is the number one cause of chronic pain, affecting 28% of adults. It not only causes pain and suffering but costs society over $100 billion dollars a year between medical costs, medications, and lost productivity. Recently an Agency for Healthcare research and Quality Evidence-based Practice Center completed a review of the treatment for lower back pain and came up with some important findings.

The first thing they found is that opioids are good for treating short-term pain but are not very effective for chronic lower back pain.

We are very concerned about opioid use for pain because of its addictive potential, its ability to impair driving and work, and because it can stop people from breathing if too much is taken. Muscle relaxers such as Flexeril and Soma were found to be effective for short to moderate term use but, like opioids, are addictive and can cause drowsiness. Nonsteroidal drugs like ibuprofen and naproxen were found to be modestly effective but the doses used should be minimized because these drugs can cause ulcers, high blood pressure, and can also counteract the benefits of low-dose aspirin therapy for patients with cardiovascular disease. Acetaminophen was not found to be effective although it is safe as long as the dose is reasonable. The take home message is this: If you have lower back pain and are given opioids, muscle relaxers, or nonsteroidal drugs, that is ok for the short-term but start working on longer term strategies that work better.

So what strategies work better for long-term use?

The strategy with the best evidence for benefits and the lowest risk of harms include rehabilitation with physical and psychological therapy. Exercise was holistically found to be helpful but not all exercises are the same so it is best when guided by a physical therapist. Yoga and Tai Chi are examples of exercises that might be effective. Periodic acupuncture, massage, and spinal adjustment are also effective therapies for longer term use but are best when combined with back stretching and strengthening exercises. Relaxation techniques, cognitive behavioral techniques, and electrical stimulation of the back were found to be possibly effective and the antidepressant duloxetine was found to be a little helpful over the long-term but more study was needed. Applying heat to the lower back can provide short-term pain relief and is a good therapy when symptoms are especially bad. In this report, they did not study the impact of magnets or topical treatments but there are some studies out there assessing these as well. Magnets do not seem to be very effective in placebo control studies but topical treatment with menthol, capsaicin, or lidocaine products can bring a little bit of relief. They are generally safe but topical products can desensitize the skin so you need to be careful if you are applying heat because you can overdo it and not realize it.

Finally, people with poor diets, smokers, and people with cancer are more prone to vitamin C deficiency. If you have a vitamin C deficiency some preliminary research has found that it does provide some modest pain relief as well and you can get your vitamin C levels checked if you fall into those categories.

- Dr. Michael White from the UConn School of Pharmacy