Blog by Nash Anderson 26/4/23

We’ve recently launched our website blog and so we believe that it’s time to provide some fascinating updates from the world of lower back pain research.

Chiropractors to the Rescue?

Did you know that patients with low back pain in the USA are less likely to receive an early opioid prescription if they initially consult a chiropractor instead of visiting an emergency department physician or advanced practice registered nurse[1]? Yep, you heard it right! Additionally, the cost of care is lowest when starting with a chiropractor and highest when starting with an orthopedist[1].

Fortunately in Australia there is a strong adherence to evidence-based practice, leading emergency doctors to avoid unnecessary procedures and medications, which translates to improved patient outcomes[1].

The Stenosis Situation

Lumbar spinal stenosis is no joke. It affects a whopping 103 million people worldwide, including 11% of older adults in the US[2]. If you’re over 60 and experiencing persistent buttock pain, leg pain, numbness, or tingling, don’t hesitate to get an early assessment[2].

First-line therapy typically involves activity modification, analgesia, and physical therapy, while long-term benefits from epidural steroid injections remain unestablished[2]. For selected patients with persistent pain and activity limitation, decompressive surgery might be an option[2]. Chiropractic is also a viable option for many cases. If you’re not sure, remember, our practitioners are highly trained to manage stenosis, especially when detected early[2].

Kids & Back Pain: What’s the Deal?

Surprisingly, between a quarter and a third of children report persistent pain, including low back pain[3]. Children are closer to being smaller adults than we realise. Considering how active they are, it makes sense that they can also complain of musculoskeletal pain. This pain is normally not necessarily associated with serious disease however persistent pain in childhood can carry into adulthood. It’s still important to have your child assessed if they complain of recurrent pain[3]. Periodic checks are recommended, especially during rapid growth phases and following trauma or injuries[3].

Medications for Low Back Pain & Sciatica: How Effective Are They?

Let’s talk about medications commonly used for low back pain and sciatica. Are they really as effective as we think?

Anti-inflammatories: Friend or Foe?

Current research reveals that non-steroidal anti-inflammatories (NSAIDs) like Nurofen and Voltaren are only slightly more effective than taking a placebo pill for improving acute and chronic lower back pain and disability symptoms[4,5].

Paracetamol: A Not-So-Reliable Remedy?

Here’s a shocker: recent research shows that paracetamol is ineffective in treating low back pain and provides minimal short-term benefits for people with osteoarthritis[6].

Pregabalin (Lyrica) for Sciatica: Yay or Nay?

Current research indicates that pregabalin doesn’t significantly reduce the intensity of leg pain associated with sciatica and doesn’t significantly improve other outcomes compared with placebo over 8 weeks[7]. Plus, there are some serious potential side effects to consider with pregabalin prescriptions[7].

In a Nutshell

There’s currently no convincing research supporting the ongoing prescription of non-steroidal anti-inflammatories and paracetamol for lower back pain, and no evidence that anticonvulsant medications like Lyrica lead to significant relief of leg pain for sciatica patients. Also back pain in adults and children and those with stenosis is more common than we realise which can lead to some negative health outcomes like opiod usage.

That’s all for now, folks! Stay tuned for more exciting updates in the ever-evolving world of lower back pain research. Remember, it’s always essential to consult your healthcare professional before making any decisions about your treatment plan. I hope this blog has helped you to stay informed today. We can look to provide more updates in the future if you’re finding them helpful.

If you have questions with regards to managing your lower back pain or are seeking to take action – book online or get in contact with our practice.

References

  1. Harwood KJ, Pines JM, Andrilla CHA, Frogner BK. Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US. BMC Health Serv Res. 2022 May 23;22(1):694. doi: 10.1186/s12913‐022‐08092‐1. PMID: 35606781; PMCID: PMC9128255.
  2. Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA 2022; 327(17):1688‐1699.
  3. Leite MN, Kamper SJ, Broderick C, Yamato TP. What works when Treating children and adolescents with low back pain?. Journal of Orthopaedic & Sports Physical Therapy 2022 May 18:1‐18. doi: 10.2519/jospt.2022.10768. Epub ahead of print. PMID: 35584032.
  4. Wendelien H van der Gaag et al, Non-steroidal anti-inflammatory drugs for acute low back pain. 2020 Cochrane database of Systematic reviews
  5. Wendy TM Enthoven et al, Non-steroidal anti-inflammatory drugs for chronic low back pain. 2016 Cochrane database of Systematic reviews
  6. Gustavo C Machado et al, Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ 2015
  7. Mathieson et al, Trial of Pregabalin for Acute and Chronic Sciatica 2017 New Eng J Med
Categories: Chiropractic