Drug for back pain may be doing more harm than good

When it comes to relieving lower back pain, there are just a handful of medications that do the heavy lifting, and one may be doing more harm than good.

Newly published Australian research has found muscle relaxants are largely ineffective and potentially unsafe when treating lower back pain, despite being widely prescribed.

Lower back pain is the leading cause of disability worldwide and muscle relaxants, most commonly traded as Valium and Xanax, are the third most frequently prescribed drugs for lower back pain, despite little evidence that they offer any meaningful relief.

The first line of treatment for acute lower back pain is over-the-counter paracetamol, ibruprofin and aspirin, which are often taken together to more effectively ease pain and swelling. This method also reduces the dose of each drug group, lowering the risk of harm, such as stroke for anti-inflammatories, stomach ulcers for aspirin, or liver damage for paracetamol, which is the No. 1 pharmaceuticals query to Australian poisons centres.

When pain is severe or chronic, clinicians may prescribe stronger anti-inflammatories, muscle relaxants, antidepressants and, as a last resort, opioids.

Read more: Opioid use down after NSW back pain trial

But there is mounting evidence that muscle relaxants, most often prescribed to treat anxiety, insomnia, panic and seizures, and symptoms of alcohol withdrawal, offer little to no relief for back pain.

Published last week in the British Medical Journal, research by Neuroscience Research Australia (NeuRA) and the University of NSW has shown they may reduce pain in the short term, but the effect is too small to be considered clinically meaningful, and there is an increased risk of side-effects. 

The study examined 31 randomised controlled trials of muscle relaxants, including non-benzodiazepine antispasmodics, compared with a placebo, usual care, waiting list, or no treatment in some 6500 adults reporting non-specific lower back pain.

Researchers assessed whether muscle relaxants were effective (reducing pain and alleviating disability), acceptable (if the drug was discontinued for any reason) and safe (no major side-effects).

The results surprised Professor James McAuley, director of NeuRA’s Centre for Pain IMPACT and the School of Health Sciences UNSW.

“We found that muscle relaxants might reduce pain in the short term, but on average the effect is probably too small to be important and most patients wouldn’t be able to feel any difference in their pain compared to taking a placebo, or sugar pill,” said Prof. McAuley.

“We were surprised by this finding as earlier research suggested that muscle relaxants did reduce pain intensity. But when we included all of the most up to date research, the results became much less certain.” he said.

“There is also an increased risk of side-effects.”

They include drowsiness, confusion, unsteadiness, slurred speech, muscle weakness, irregular heartbeat and memory problems. Long-term use can lead to addiction and dementia.

Read more: Drugs, drink affecting more seniors

Prof. McAuley said some, but not many, individuals with lower back pain may benefit from taking a muscle relaxant, but large, high-quality, placebo-controlled trials are urgently needed to properly test the efficacy and safety of muscle relaxants for lower back pain.

For now, they advise clinicians to discuss the uncertainty of muscle relaxants with patients considering these drugs.

“We encourage clinicians to discuss the uncertainty in the efficacy and safety of muscle relaxants with patients, including the possible reduction in pain, but also increased risk of experiencing a non-serious adverse event, to allow them to make informed treatment decisions,” Prof. McAuley said.

Read more: Fixing lower back pain

Most lower back pain goes away on its own in two to four weeks, so time and rest are often the best remedy. Other non-drug strategies include hot and cold packs, stretching, physiotherapy, wearing comfortable shoes, reducing stress, exercise, good posture and quality sleep.

And don’t forget to keep a straight back and bend at the legs when lifting heavy objects.

What strategies have you used to treat a lower back problem? Why not share your experiences in the comments section below?

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Written by Rebecca Tolan

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