NSAIDs may be a better medication than opioids for chronic lower back pain

Oct 5 2011
When it comes to treating chronic lower back pain with medication, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be preferable over opioids and antidepressants, according to new research published Oct. 1 in Spine.

The spinal column consists of the vertebrae, the facet joints that connect the bones and the intervertebral discs, which act as shock absorbers during movement. Back pain may be the result of injury, disease or age-related damage to any of these structures. This may include herniated discs, which can put pressure on the surrounding nerves, or spinal stenosis, in which parts of the canal narrow on the spinal cord. Overexertion can also put strain on the muscles and ligaments.

Back pain is the leading neurological condition, second only to headaches. It is a major financial burden to the healthcare system as well as to workers with lost wages.

It is best to approach chronic pain through conservative, non-surgical treatments, if possible. This may include certain exercises, acupuncture, physical therapy or certain medications.

Doctors have prescribed different kinds of drugs to their patients, including NSAIDs such as ibuprofen and opioids such as hydrocodone. Some people even received prescriptions for antidepressants for back pain, though the effectiveness of this treatment is questionable, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a division of the National Institutes of Health.

A research team decided to evaluate the therapeutic values of different drugs for chronic lower back pain by reviewing several randomized control trials collected by the Cochrane Collaboration. The results showed that NSAIDs and opioids are both effective when compared to placebos, but because opioids come with more side effects, they should be avoided, if possible. NSAIDs have side effects as well, such as stomach discomfort, according to NIAMS. However, opioids may lose their potency because of habituation in the long term, the study said.

Meanwhile, antidepressants are not effective in treating chronic lower back pain compared to placebos, according to the researchers.

The studies reviewed by the team also suggest that subgroups of patients respond differently to medication, and that paying attention to these subgroups may target treatment to make it more appropriate.