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Keep it Simple: Conservative Treatments for Chronic Back Pain Show Better Results Than Drastic Action with Drugs

Posted on Aug 16, 2013 by Sergio Ulloa ()  | Tags: antibiotics, back pain, chronic back pain, Denmark, narcotics, research, US

A recent article published in JAMA Internal Medicine, a Journal of the American Medical Association Network publication, has highlighted how modern doctors deal with patients who come to them concerned about back pain. According to the studies, an increasing number of cases of back pain have been reported, and in the US, it is estimated that 10 per cent of all visits to the doctor are connected to back pain.

According to the original study, lead by Dr. Bruce Landon who was assisted by his colleagues from the Harvard Medical School in Boston, treatments for back problems in the US have changed quite considerably over the last ten years. Landon worked with his team to track nationally-representative data on outpatient visits for back and neck pain, Altogether the study collates data from two US national surveys, which represent almost 24,000 visits to the doctor between 1999 and 2010.

They found that, newer treatments tend to focus on powerful narcotic drugs to numb the pain as opposed to a decade ago when conservative treatments which are based on a combination of anti inflammatory drugs and physical therapy, were much more common. Landon's team also noted a 10 per cent increase in prescriptions for narcotic drugs as a treatment for back pain, meanwhile the number of cases where doctors recommended using nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen dropped from almost 37% in 1999 to about 24.5% in 2010.

In addition, the surveys also found that a surprisingly high number of back pain patients were ordered to undergo CT or MRI scans. The study indicated that about 11% of people with back pain had had a scan between 2009 and 2010 which was an increase of 4% in a decade. Doctors warn that ordering scans, just like injections, should be reserved exclusively for cases where patients have  suspected nerve damage.

Earlier this year, a different publication about back pain took European medical circles by storm, when research celebrated the use of antibiotics to treat chronic back pain. As a result of the publication, newspapers were full of stories about the merits antibiotics to tackle long term back conditions, and The Independent even went as far as to announce that 500,000 sufferers of back pain 'could be cured with antibiotics'."

This, and other similarly bold statements were based on the results of research conducted at university hospitals in Denmark and published in the peer - reviewed European Spine Journal. The original published the findings of two separate studies; one which identified a connection between bacterial infection in patients with back pain whereby 46% of a sample of 61 patients suffering from spinal disc herniation (commonly known as a slipped disc). The second study investigated 162 patients with slipped disks and who showed signs of bone swelling in their lower back. 50% of these patients were treated with a course of antibiotics for 100 days and the other 50% were given an identical placebo. The results indicate a positive reaction to the antibiotics, with patients reporting less pain, improved sleep and better movements on their final follow-up (one year later).

While the study certainly represents encouraging news for the medical world, with one neurosurgeon Peter Hamlyn, going so far as to declare the research "the stuff of Nobel Prizes", the researchers have reminded the public that these initial studies were very small, and therefore it is too early to conclude whether antibiotics will lead to overall improvements in back conditions.

Just as US researchers fear that prescribing opioids to patients with back pain could lead to more severe problems like narcotics abuse and addiction, the worry is that the newly published Danish research will lead to over prescribing antibiotics. The long term consequences here are that over exposure to antibiotics can result in individual patients and the wider community becoming resistant to antibiotics over time.

Statistics from National Institutes of Health indicate that eight out of ten people have back pain at some point in their lives, so there is clearly a need for continued research in the area. Nevertheless, the widespread nature of the problem, and the fact that there are so many possible causes of back pain, indicate that powerful drugs like narcotics and antibiotics are not the necessary course of action for most patients.

Unless patients report severe, disabling back pain or complain of accompanying symptoms such as a fever of 38ºC (100.4ºF) or above, pain in the chest or legs and below the knees then they are encouraged to treat it with over-the-counter medicines. Increasingly, doctors are advised to tell patients about the merits of stretching and physical exercise to improve their condition and reduce back pain in the long term.

Dr. Bruce Landon who conducted the US research, made a statement to Reuters Health, reminding the public- and doctors- that 95 per cent of patients will recover from back pain with a little bit of time and conservative treatment. "The key thing for patients is, give it time," he stated.

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