Pain killers and back pain

For many years for many people taking pain killers such as paracetamol or ibuprofen has been the first line of treatment to get relief from back pain. But recent evidence is emerging to show that this might not actually be as beneficial as we thought. In this blog I am going to look at some recent evidence and some changes to GP clinical guidelines on pain relief for back pain.

When someone has back pain the advice has generally been to keep active and take pain killers such as paracetamol or anti-inflammatories and the pain should ease before a couple of weeks. As a Chiropractor I would take a more proactive approach and possibly add in manipulation and/or specific exercises and/or work on the muscles. I will talk about the merits of each of those in a separate blog but in this blog I am focusing on pain killers for back pain.

There has recently been some new guidelines published both in the UK (the NICE guidelines) and in America from the American college of physicians. What is interesting about both guidelines is the decrease in pharmacological recommendations. I.e less recommendations for pain killers. The NICE guidelines no longer recommend paracetamol as it has been shown to be no more beneficial than a placebo (dummy pill), but instead recommend ibuprophen as even though it has more side effects it has been shown to be more beneficial. American guidelines actually do not recommend any drugs as a first line approach but to offer non-drug based approaches eg exercises and manipulation. Only adding in anti-inflammatories if non-drug based approaches have been unsatisfactory.

I think these guidelines highlight an important shift in the way the medical community treat back pain. As more evidence emerges on the benefits and risks of the different strategies to treat back pain it is becoming more clear that drugs are not a solution. What is promising for me as a Chiropractor is that the interventions I use to treat back pain are in the recommendations. Manipulation and exercise play a key part. When I first graduated as a Chiropractor there was some scepticism about our approach and still now I hear of patients assuming GP’s “don’t recognise Chiropractors” I am happy to say that things are changing. Chiropractic is a government regulated profession and the approach we take to treating patients with back pain is recommended in the guidelines published for GP’s.