Study questions value of pricey back pain drugs

Australian research published in the latest issue of the British medical journal The Lancet has found that a combination of paracetamol and gentle exercise is just as effective.

Chiropractors and physiotherapists provide some of the more expensive forms of treatment for lower back pain, while over-the-counter anti-inflammatory drugs are often the first thing sufferers reach for when pain occurs.

But there has been concern over the side-effects of some non-steroidal anti-inflammatory drugs.

Earlier this year one brand of an osteoarthritis drug, which has since been deregistered in Australia, was linked to serious liver side effects. Gastroenterologists have also raised concerns about the damage anti-inflammatory drugs can do to the stomach and bowel.

Findings like these were part of the reason Mark Hancock from Sydney University's Back Pain Research Group decided to research whether those treatments were really necessary.

"There's been quite a bit of research recently showing that there are potential serious side effects," he said.

"They're rare, but they exist in patients taking anti-inflammatories.

"So, like any treatment in deciding whether to prescribe it or take it, it's important to understand both the benefits and also the risks associated with it."

Mr Hancock and his team studied 240 patients suffering from acute lower back pain.

Each had been given paracetamol and advice from his or her GP. The patients were then randomly divided into four groups.

Some were given placebo therapy and placebo drugs. Others were given anti-inflammatory drugs, or spinal manipulative therapy, or both.

The study concluded that spinal manipulative therapy and non-steroidal anti-inflammatory drugs do not necessarily lead to faster recovery from acute lower back pain.

"The main thing we're interested in looking at in this trial was if patients actually received care from their GP first, which is widely recommended of advice from paracetamol, do patients then gain additional benefit from receiving spinal manipulative therapy or non-steroidal anti-inflammatory drugs?" Mr Hancock said.

"And what we found was that they didn't. So if they received the widely recommended care of regular paracetamol and advice, they gained no additional benefit from the other treatments."

Mr Hancock says the advice given by the GPs is generally to stay active.

"So for quite a while, patients thought that actually going to bed was the best thing for their back pain," he said.

"But it's been clearly shown to be the opposite. So, within reason, staying reasonably active is actually good for acute back pain." © 2007 Australian Broadcasting Corporation