The Indian Express (Delhi Edition)
When your back hurts, don’t pop a pill; go run, be active
Drjamesweinstein,abackpainspecialistand chief executive of Dartmouth-hitchcock Health System, has some advice for most people with lower back pain: Take two aspirins and don’t call me in the morning.
Recently, the American College of Physicians published updated guidelines that say much the same. In making the new recommendationsforthetreatmentofmostpeople with lower back pain, the group is bucking what many doctors do and changing its previous guidelines, which called for medication as first-linetherapy.nitindamle,presidentofthe group’s board of regents and a practicing internist, said pills, even over-the-counter pain relievers and anti-inflammatories, should not be the first choice. “We need to look at therapiesthatarenonpharmacologicalfirst,”hesaid. “That is a change.”
The new guidelines said that doctors should avoid prescribing opioid painkillers for relief of back pain and suggested that before patientstryanti-inflammatoriesormusclerelaxants, they should try alternative therapies like exercise, acupuncture, massage therapy oryoga.doctorsshouldreassuretheirpatients that they will get better no matter what treatment they try, the group said. The guidelines also said that steroid injections were not helpful, and neither was acetaminophen, like Tylenol,althoughotherover-the-counterpain relievers like aspirin, naproxen or ibuprofen could provide some relief.
Weinstein said patients have to stay active and wait it out. “Back pain has a natural course that does not require intervention,” he said.
In fact, for most of the people with acute back pain — defined as present for four weeks or less that does not radiate down the leg — there is no need to see a doctor at all, said Dr Rick Deyo, a spine researcher and professor at the Oregon Health and Science University in Portland, and an author of the new guidelines. “Foracutebackpain,theanalogyistothecommon cold,” Deyo said. “It is very common and very annoying when it happens. But most of the time it will not result in anything major or serious. ”
Even those with chronic back pain — lasting at least 12 weeks — should start with nonpharmacological treatments, the guidelines say. If patients still want medication, they can try over-the-counter drugs like ibuprofen or aspirin. Scans, like an MRI, for diagnosis are worse than useless for back pain patients, members of the group said in telephone interviews. The results can be misleading, showing what look like abnormalities that actually are not related to the pain.
It is surprising, some experts in back pain say, how often patients are helped by treatments that are not medical, even by a placebo that patients are told at the start is really a placebo. Dr Christopher J Standaert, a spine specialist at the University of Washington and Harborview Medical Center, cited a study in which patients with chronic low back pain were offered a placebo, and were told it was a placebo, along with their usual treatment — often an anti-inflammatory drug like ibuprofenornaproxen.or,thepatientsremainedwith their usual treatment alone.
Thosetakingtheplaceboreportedlesspain and disability than those in the control group who did not take it. The placebo effect, although modest, was about the same as the effect in studies testing nonpharmacological treatments for back pain like acupuncture, massage or chiropractic manipulations.
Many people with chronic back pain tend to shut down, avoiding their usual activities, afraid of making things worse, Standaert said. Helping them is not a matter of prescribing drugsbutratherteachingthemtosetgoalsand work toward returning to an active life, even if they still have pain.
“They have to believe their life can get better,” Standaert said. “They have to believe they can get to a better state.”
“Patients are looking for a cure,” said Dr Steven J. Atlas, a back pain specialist at Massachusetts General Hospital. “The guidelines are for managing pain.” Added to the problem are the incentives that push doctors and patients toward medications, scans and injections, Deyo said. “We have the cure. You can expect to be cured. You can expect to be pain free.’”
Weinstein has a prescription: “What we need to do is to stop medicalising symptoms,” he said. Pills are not going to make people better and as for other treatments, he said, “yoga and tai chi, all those things are wonderful, but whynotjustgobacktoyournormalactivities?”
“I know your back hurts, but go run, be active, instead of taking a pill.” NYT