A TV doctor has warned that certain drugs commonly used for back pain either won't work or could make the condition worse. Over 10 million adults in the UK suffer from back pain annually, and around 58% of British adults will experience low back pain at some point in their lives, making it a leading cause of long-term sickness and disability.
Guidelines often ignored
Doctor Mark Porter, a GP who has appeared on BBC Breakfast, Good Morning Britain, and Lorraine, said the way people manage back pain is simply wrong, with many doctors ignoring guidelines. He said: "Despite long-established UK guidelines on best practice, which have just been updated by the National Institute for Health and Care Excellence (Nice), we are still making the same mistakes. Put simply, too many people are doing the wrong thing, taking the wrong medication or having the wrong investigations."
A recent study of consultations at a GP surgery in Glasgow found that guidelines were not followed in six out of ten cases. Dr Porter wrote in the Times: "It was a small sample and impossible to extrapolate to the whole UK, but it reflects data from other studies, including another recent one based on emergency department attendance in the US. This found similar divergence from the guidelines, with one in five people given opioid painkillers such as codeine and morphine (these should be avoided in back pain where possible) and too many (nearly 40 per cent) having spinal x-rays that were unlikely to help."
What to avoid
Dr Porter listed several things people should avoid when treating a bad back: "Avoid supportive belts, corsets, corrective shoe insoles, Tens (transcutaneous electrical nerve stimulation) machines and acupuncture, and don’t rely on paracetamol. It’s generally harmless if you stick to the right dose, but research shows that it doesn’t work for this type of pain. Nice also recommends avoiding opioid painkillers except where other drugs don’t help. Opioids often don’t work that well, and may even result in worse long-term outcomes, not least opioid dependence, which can leave people still in pain but addicted and sedated."
Nice also advises against medicines for short-term nerve pain, such as the old-fashioned antidepressant amitriptyline and newer drugs like pregabalin and gabapentin (though amitriptyline is still used for chronic pain). For sciatica, nerve pain typically in the leg, diazepam should not be used.
Recommended painkillers
The painkillers of choice for acute back pain are non-steroidal anti-inflammatory drugs (NSAIDs). Dr Porter said: "If you are self-treating it will be ibuprofen, which is available over the counter, but if under the care of a doctor it will probably be naproxen." NSAIDs can cause serious side-effects, including kidney problems and life-threatening stomach bleeds, so they are often prescribed alongside something to protect the stomach, such as omeprazole.
Investigations and surgery
Dr Porter also advised against expecting an x-ray or scan: "Do not expect an x-ray or scan. There are situations where they are important but, in general, they don’t help and, in the case of x-rays, expose you to unnecessary radiation. MRIs don’t involve ionising radiation so are safer, but are expensive, often pick up irrelevant wear and tear, and are not always helpful."
He also cautioned against pushing for surgery: "Don’t push for surgery. This is rarely offered in acute back pain but can be an option for some people, including those with severe sciatica. I underwent a microdiscectomy 20 years ago having been in agony for months with a weak left leg. It worked a treat, but long-term outcomes for those who have this type of surgery for a prolapsed disc are often no better than they are for those who heal naturally, so avoid it if you can. I still have occasional sciatica now."
Stay active
He emphasized the importance of staying active and going to work, as resting could lead to weakness and slower recovery. Dr Porter added: "As a rule people who remain active, and at work, tend to fare better. And consider an active exercise programme."
He concluded: "To summarise: if you develop back pain after some DIY next weekend, assuming you don’t have any of the red flags below, current advice would be to take ibuprofen, stay as active as possible and head off to work as usual on Monday. Most cases improve gradually within 4–6 weeks, but if yours hasn’t, see your GP."
