- Lower back pain affects millions of people and is the leading cause of disability globally.
- Many people turn to anti-inflammatories or steroid use in the short term to ease their pain.
- However, a new study found that this may actually prolong the pain.
Low back pain affects up to 80% of people at some point during their lives, and, more often than not, we head for anti-inflammatories and steroids to give us some relief.
But overusing drugs like ibuprofen and dexamethasone, in the short term, could do more harm than good. According to a new study, it could increase one's chances of developing chronic pain.
Writing in Science Translational Medicine, they say that these findings may have a significant impact on medical treatment of lower back pain.
“Specifically, our data suggest that the long-term effects of anti-inflammatory drugs should be further investigated in the treatment of acute LBP (low back pain) and likely other pain conditions."
Global back pain burden
Being immobilised by low back pain is a common global problem – it affects 540 million people (or more than 1 in 10 people) – worldwide, according to a report in The Lancet.
In South Africa, lower back pain affects up to 30–40 % of South Africans at some point in their lives, the KwaZulu-Natal Health Department indicates.
The cost and burden of chronic low back pain cannot be ignored. Multiple studies and experts have shown how, apart from negatively affecting a person’s quality of life, it also has an economic impact when sufferers are absent from work or are less productive as a result of their pain.
To gain a better understanding of low back pain, the researchers from McGill University, Canada, searched for molecular markers in the blood that would predict which patients would have pain that quickly disappears and who would have ongoing pain.
Blood samples were initially taken from 98 participants with back pain, and then again three months later.
They found that neutrophils, a type of white blood cell that helps the body fight infection, play an important role in resolving pain.
“Neutrophils dominate the early stages of inflammation and set the stage for repair of tissue damage. Inflammation occurs for a reason, and it looks like it’s dangerous to interfere with it,” co-author Jeffrey Mogil, a professor in the department of psychology at McGill University, said in a news release.
Replicating the findings
The team replicated the findings in mice. They blocked neutrophils in mice, and found that this prolonged the pain up to ten times. When treating the pain with anti-inflammatory drugs and steroids, it produced the same result – although these were initially effective against pain.
A separate analysis of 500 000 people in the UK supports these findings, and showed that people who took anti-inflammatories to treat their pain were more likely to have pain two to ten years later. This effect, however, was not seen in those who took acetaminophen (paracetamol) or anti-depressants.
“For many decades, it’s been standard medical practice to treat pain with anti-inflammatory drugs. But we found that this short-term fix could lead to longer-term problems,” said Mogil.
Reliability of study
However, some experts urge caution in interpreting these results too broadly, as the researchers didn’t conduct a clinical trial (the "gold standard" of research). Instead, their research was purely observational
“It’s intriguing but requires further study,” Dr Steven Atlas, director of the primary care practice-based research and quality improvement at Massachusetts General Hospital, told The New York Times.
The authors also acknowledged the limitation of not including control subjects without any low back pain, and added this should be included in additional research incorporating a clinical trial.
“We discovered that pain resolution is actually an active biological process,” said co-author Luda Diatchenko, a professor in the Faculty of Medicine and Faculty of Dentistry. “These findings should be followed up by clinical trials directly comparing anti-inflammatory drugs to other pain killers that relieve aches and pains but don’t disrupt inflammation.”
Reconsidering pain treatment
Atlas told The Times that while short-term use of anti-inflammatories is likely not harmful, the new research, which doesn’t prove that long-term use is harmful, “at least gives a biological mechanism that says short term use is not the same as long term”.
Dr Massimo Allegri, another co-author and a physician at the Policlinico of Monza Hospital in Italy, said their findings suggest that it may be time to reconsider the way acute pain is treated.
“Luckily pain can be killed in other ways that don’t involve interfering with inflammation,” he said.
A 2018 Stellenbosch University study found that the first line of treatment for lower back pain should be education and advice on how to keep active and remain at work.