Anyone who has ever experienced low back pain knows how debilitating it can be. Sometimes it can make moving or even just deep breathing, challenging. Health professionals have been debating the best ways to ease low back pain. Manipulation often gets dismissed as unproven. But drugs don’t work well, and doctors don’t have much else to offer. A new study suggests that osteopathic manipulation may have benefits.
Drugs to Ease Low Back Pain:
NSAIDs:
NSAIDs are probably the most recommended treatments to ease low back pain. Drugs like ibuprofen and naproxen are available without a prescription. They may help a bit, but they come with side effects that include high blood pressure, stomach irritation and kidney problems.
How effective are NSAIDs to east low back pain?
A review in JAMA (June 13, 2017) concluded:
“Bottom line: Compared with placebo, NSAIDs are associated with a small but significant improvement in pain and disability in patients with chronic low back pain, although this difference became nonsignificant when studies with high risk for bias were excluded. The associated benefits were smaller than the minimal clinically important difference.”
Benzos and Muscle Relaxants:
Doctors have prescribed benzodiazepines or muscle relaxants to ease the spasms associated with low back pain.
Here is a systematic review and meta-analysis of such meds (European Journal of Pain, Feb. 2017):
“There is no evidence for the efficacy of benzodiazepines in LBP [lower back pain]. For people with acute LBP, muscle relaxants provide clinically significant short-term pain relief. For chronic LBP, the efficacy of muscle relaxants is largely unknown. There was no eligible RCT [randomized controlled trial] evidence to support the efficacy of benzodiazepines in LBP. Prolonged use of these medicines in LBP cannot be guided by trial evidence.”
Opioids to Ease Low Back Pain:
A review in the BMJ (Jan. 5, 2015) concluded:
“Opioids seem to have short term analgesic efficacy for chronic back pain, but benefits for function are less clear. The magnitude of pain relief across chronic non-cancer pain conditions is about 30%. Given the brevity of randomized controlled trials, the long term effectiveness and safety of opioids are unknown. Loss of long term efficacy could result from drug tolerance and emergence of hyperalgesia. Complications of opioid use include addiction and overdose related mortality, which have risen in parallel with prescription rates. Common short term side effects are constipation, nausea, sedation, and increased risk of falls and fractures. Longer term side effects may include depression and sexual dysfunction.”
Osteopathic Manipulation for Low Back Pain:
A randomized controlled trial (JAMA Internal Medicine, May, 2021) suggests that osteopathic manipulative treatment might be helpful. Four hundred French patients with low back pain received six sessions of either genuine or sham osteopathic manipulative treatment. After both three months and a year, the genuine treatment resulted in less limitation of activity. The difference, while statistically significant, was modest.
The Bottom Line to Ease Low Back Pain:
There do not appear to be any magic bullets for lower back pain. Many people swear by spinal manipulation.
A systematic review and meta-analysis published in the journal Complementary Therapies in Medicine (Jan. 2021): concluded:
“Results strengthen evidence that osteopathy is effective in pain levels and functional status improvements in NS-CLBP [non-specific chronic low back pain] patients. MFR [myofascial release] reported better level of evidence for pain reduction if compared to other interventions. Further high-quality RCTs, [randomized controlled trials] comparing different osteopathic modalities, are recommended to produce better-quality evidence.”
What is Your Experience?
Please share your experience with low back pain in the comment section below. What works for you?
