If over-the-counter painkillers don’t seem to help that nagging ache in your back, you’re not alone. New research suggests that non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen provide little relief for back pain sufferers—and have the potential to cause serious side effects, as well.
Researchers from Australia’s George Institute for Global Health conducted a meta-analysis of 35 previously published clinical trials, with more than 6,000 participants total. The results, published in the Annals of the Rheumatic Diseases, found that only one in six people taking NSAID pills for back pain experienced a meaningful reduction in their symptoms compared to those who took placebo pills. People who took NSAIDs were also 2.5 times more likely than those who didn’t to report gastrointestinal problems, including stomach ulcers and bleeding. The trials included both over-the-counter and prescription-strength NSAIDs.
So why don’t these drugs work for back pain—and if they don’t work, what does? We posed these questions to Jesse Bible, MD, an orthopedic spine surgeon at Penn State Health Milton S. Hershey Medical Center.
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First, says Dr. Bible, it’s important to understand that the new study included people who suffered from general spinal pain (often caused by age, wear and tear, and arthritis) as well as sciatica, a specific type of pain caused by herniated disks or other nerve problems.
Back pain caused by age or arthritis is inflammatory, says Dr. Bible, but sciatica isn’t. So it makes sense that NSAIDs wouldn’t work very well to relieve sciatica pain—and that, when sciatica is included in this type of analysis, the benefits of NSAIDs will be less significant overall.
So if you’re popping pain meds and not getting relief, the first thing you should do is figure out what’s causing your back pain. Your doctor can help you, but here’s a hint: If the pain in your back also shoots down one or both legs, there’s a good chance it’s nerve-related.
The good news is, sciatica often clears up on its own in a few weeks to months, says Dr. Bible. In the meantime, your doctor may prescribe physical therapy and/or oral steroids to provide some relief.
If your back pain isn’t nerve-related, it’s probably caused by inflammation—and there’s a better chance that NSAIDs will provide at least a little relief. But, Dr. Bible admits, they don’t work for everyone.
“I think most people who have experienced back pain know that over-the-counter medicines aren’t going to be a panacea,” he says. “What we recommend is a variety of lifestyle modifications and treatments that can help in addition to taking a pill.”
“You want to surround your spine with a strong foundation—your ab muscles, your obliques, your spinal muscles,” he says. “The more those are activating and working well, the less weight and tension the spine has to bear itself.”
Stretching can be beneficial, too, by keeping muscles loose and reducing your risk of further injury. A recent Cochrane Review concluded that yoga may relieve pain and improve function, at least temporarily, for sufferers of chronic back pain. (The study authors say to proceed with caution, however, because yoga and other types of exercise can sometimes make back pain worse.)
Dr. Bible also tells his patients to experiment with heating pads or ice packs, and learn what feels good to them. “A lot of people are able to find a routine of activity modification that works for them,” he says. “They’ll say, ‘I know if I go play golf today I’ll have to sit on the couch for a few hours tonight with a heating pad.’”
If a patient doesn’t want or isn’t able to take NSAIDs because of gastrointestinal or kidney issues, Dr. Bible says acetaminophen is also an option to “help take the edge off.” Some patients will also chose to alternate NSAIDs and acetaminophen so they’re taking smaller amounts of each.
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Most people with chronic back pain won’t find one thing that cures them completely, says Dr. Bible. But trial and error—and a combination of different treatments—can help make people much more comfortable.
And although Dr. Bible is a spinal surgeon, he rarely recommends surgery for inflammatory or sciatica-related back pain. (That’s generally reserved for cases involving acute injuries, or as a last resort for chronic pain.)
“The research shows that you’re much better off finding a potpourri of lifestyle therapies that work for your routine, to help keep you active and provide some relief,” he says.