(Montreal) Even after decades of research, there is currently no conclusive evidence on the efficacy or safety of analgesics in the treatment of acute back pain, warns a new meta-analysis.
Some of these painkillers might even come with unwanted side effects like nausea, vomiting, dizziness, and headaches.
Pending the publication of better quality clinical trials comparing analgesics, write the Australian authors of the new meta-analysis, “Clinicians and patients are advised to exercise caution in the management with analgesics of acute non-specific low back pain”.
“It tells us that the drugs are not very effective, but that’s also what we see in the clinic,” commented the head of the chronic pain department at the CHU de Québec-Université Laval, Dr. Anne-Marie Pinard. .
“The drugs will usually take away between 30 and 50 percent of the pain. There is no medicine that will obliterate the pain or completely cancel it out. Medications have some effectiveness, but the rest must be taken care of by other modalities. »
The meta-analysis focused on around 100 studies carried out between 1964 and 2021. These studies included some 15,000 patients who were prescribed molecules as common as paracetamol (Tylenol), ibuprofen (Advil) and codeine for their back pain lasting less than six weeks, but also obscure drugs that are sometimes no longer used today.
Despite the limitations of medication, Dr. Pinard said, we cannot stand idly by when faced with a suffering patient. Consideration should therefore be given to complementary interventions such as rehabilitation, visualization, relaxation, and breathing, each of which has “good efficacy”.
Each patient will be able to develop their strategy, but “spectacular” results should not be anticipated with the medication, she stressed.
“It’s the ‘creative’ part of medicine,” explained the specialist. This is the part that allows us to try to adapt a treatment to the particular situation of a patient with the scientific knowledge that we have. But also, human interaction will allow us to find a solution that will be the most adapted to the particular situation of a patient. »
Pain treatment specialists frequently encounter patients who are looking for a quick, effortless solution that will make their pain disappear instantly (or almost).
It is therefore easier to convince a patient to take two tablets in the morning than to convince him to stick to a physiotherapy program of several weeks.
“It’s the daily life of my clinic,” said Dr. Pinard. But I often tell my patients that my clinic is not like a garage, you can’t bring your body to us like you would bring your car to us and we’ll call you when it’s settled. It takes involvement. »
Especially, she continues, that patients may be called upon to modify “questionable” lifestyle habits that may contribute to their pain. Several health problems, including low back pain, would not occur (or would occur less often) if people were more active or ate better, she recalled.
“People are used to looking for a solution that is a bit external, that will solve the problem when sometimes there is part of the problem that comes from the inside,” said Dr. Pinard.
Lower back pain is a “super good example,” she added. Patients who have had back pain for several years may be relieved by teaching new habits and an exercise program, only to give up after eight or ten weeks when they begin to feel better.
“They are happy, but we see them again for the same thing after two or three years because they stopped doing their exercises because it was going well,” she lamented. People are going back to their old ways of life, and they come back to us a little discouraged. »
A meta-analysis like this will not change the practice of doctors who must find a solution to relieve the pain of their patients, she said in conclusion. However, it could come to fuel a discussion between the doctor and his patient on the limits of the medication.
“If it helps us to let people know that no, the pills don’t necessarily do the job that people want them to do and that there’s work to be done on yourself, I think that’s really interesting on that aspect,” said Dr. Pinard.
The findings of this study were published by the prestigious medical journal The BMJ.