Chronic back pain is a common medical complaint. Many people find that as they get older, their lower back begins to ache more and more. In fact, on BMJ study suggests that somewhere between 1/3 and 2/3 of the population suffers from chronic lower back pain. Why then are treatments for this condition so elusive? What is currently available and what breakthroughs are on the horizon?
Long-term pain management medication: What’s available?
There are currently a number of treatments, both medical and therapy related, available to treat chronic back pain. When you see your family practitioner, the first thing he will usually recommend is NOT to rest and to take painkillers. Most incidences of back pain will clear up following a few weeks and so oral NSAID’s are adequate for this (NSAID is short for a non-steroidal anti-inflammatory drug which basically means these drugs, like Aspirin and Ibuprofen, reduce inflammation which is a cause of pain. Reduced inflammation, therefore, leads to reduced pain). If this doesn’t touch the pain, or the pain is continuing for more than 6 weeks, your doctor may recommend a short course of weak opioid drugs. These include morphine but shouldn’t be taken long term due to their addictive properties. Some doctors may offer alternative drug therapies like SSRI’s (typically used in depression) or anticonvulsants ( the drug typically used for epilepsy) however there isn’t much evidence to support the use of these drugs.
Some doctors may recommend topical NSAIDs or muscle relaxants. These are creams or gels and are applied directly the surface of the skin (where the pain is). Others may recommend massage or physiotherapies. In rare instances, you may be offered steroid injections into the spine. Steroids work, similarly to NSAIDs, to reduce inflammation and therefore pain.
Chronic back pain medication: Where next?
Above we discussed the typical treatment options that doctors recommend for chronic back pain. However new (or in some cases very old!) treatments are also available. Many of these aren’t recommended as they don’t have a good evidence base – ie there is not good scientific data to suggest they actually work…yet. A promising therapy could be surgical pumps. These are surgically implanted devices that constantly release a low level of pain medication into the patient’s spine allowing for continuous pain relief. This won’t solve the root cause of the back – which in many cases is unknown – but it could help patients who have explored all other routes and haven’t found a solution. Another is spinal cord stimulation. This works by implanting a device under the spine that electrically stimulated the spine to reduce pain. It is a similar principle to spinal pumps but doesn’t use injectable medication but electricity instead.
As we have seen, there are current therapies available for chronic back pain but they are currently inadequate. New therapies like surgical pumps or spinal stimulation could be the answer to a growing problem that affects a significant proportion of the population.