Chris Smyth, Health Editor
February 3 2017, 12:01am, The Times
The Nice review concluded that exercise and psychological therapy appeared to be the only effective treatments for chronic back pain.
Taking drugs for back pain is largely pointless, an overview of research has concluded.
Anti-inflammatory pills such as ibuprofen are widely used as a first choice for patients with lower back pain. However, scientists found that they made so little difference that most people would not notice the effect. Exercise is usually recommended instead, which for some patients could include Pilates, yoga or stretching.
With paracetamol previously shown to be ineffective and opiates of little help, the findings mean that there is no good drug treatment for a condition that affects one in ten people.
Manuela Ferreira of the George Institute in Sydney, senior author of the study, said: “Back pain is the leading cause of disability worldwide and is commonly managed by prescribing medicines such as anti-inflammatories. Our results show anti-inflammatory drugs actually only provide very limited short-term pain relief. They do reduce the level of pain but only very slightly, and arguably not of any clinical significance.”
Her team analysed 35 trials involving 6,000 patients using non-steroidal anti-inflammatory drugs (NSAIDs), of which ibuprofen is one of the most common, for conditions such as back and neck pain and sciatica.
Only one in six patients treated with the drugs received any pain relief that they would not have got from a placebo, and that was so small it probably made no difference to their lives, they report in the Annals of the Rheumatic Diseases.
The drugs more than doubled the risk of problems such as bleeding and stomach ulcers. Dr Ferreira said: “When you factor in the side-effects, which are very common, it becomes clear these drugs are not the answer to providing pain relief to the many millions of [people] who suffer from this debilitating condition every year.”
A study in 2015 found that back pain had overtaken heart disease as the biggest cause of years spent in ill health in Britain. Gustavo Machado, another of the researchers, said that sufferers “are taking drugs that not only don’t work very well, they’re causing harm”.
Recent guidance from the National Institute for Health and Care Excellence (Nice) recommended drugs such as ibuprofen to control pain. Dr Machado said that those guidelines should not be ripped up but warned that drugs should only be prescribed after taking the risk of side-effects into account.
He said: “Patients with back pain should consider an exercise programme to help them manage their condition, eg aerobic exercises, strengthening/stretching exercises, pilates, yoga, core-stability exercises.”
The Nice review concluded that exercise and psychological therapy appeared to be the only effective treatments. Acupuncture is now considered no better than a placebo. Dr Machado said that patients were being encouraged to have tests and surgery that often did them little good because doctors failed to get to the root cause of their pain. “This is definitely a result of poor management, where patients are not properly assessed using evidence-based care,” he said. Stephen Ward, the consultant who led the development of the Nice guidance, said: “No drug seems to be the answer for back pain. Can they help in the short term? Probably, a bit.”
He said that averaging all patients risked masking significant benefits for some people and pointed out that only 4 per cent of those taking NSAIDs experienced side-effects. John Newton, of Public Health England, said: “Being overweight and physical inactivity are two causes of back pain that we can all do something about. Eating a good diet, moving our muscles more and raising our heart rate all help to prevent musculoskeletal problems.”
It would appear that the rug of evidence-based medicine has been well and truly pulled out from under three stalwarts of the painkilling world (Dr Mark Porter writes). So what now if paracetamol, the ibuprofen family of anti-inflammatories and codeine-type opioids don’t work for back pain? What can you take, and what can I prescribe?
First, all these drugs do work for some people; they (particularly paracetamol) just don’t work in as many as we thought. So, if they give you relief, keep taking them. Second, if your back pain is the short-lived type that settles with time despite what we doctors do, rather than because of it, and painkillers don’t help, then bin them. Why risk side-effects for no benefit? Try physiotherapy, with an exercise programme to mobilise and strengthen your back and core.
If the pain persists, ask about other options, from education and psychological support (pain management — surprisingly effective) to epidural injections and surgery (a last resort).
The news is better for sciatica and prolapsed discs. The drugs we use for this “neuropathic pain” (eg, amitriptyline) tend to work better, but even these are no panacea. The sad reality is that chronic back pain is difficult to live with, and even more difficult to treat.
After much consideration I have called the foods in Part 2 “exotic” superfoods foods from the definition of exotic as being “foreign in origin or character; not native”. These are foods that you may not of heard of. Although some are now making their way onto the shelves of large supermarkets, most are still only found in health food shops or online. Again the list of these is long and ever growing. Here are my top 5. They all make great additions to smoothies or juices to ramp up the nutrient content but also add flavour and added deliciousness.
For those that know me, maca being top of my list will be no surprise. A great favourite, which I add to smoothies, porridge and hot almond or coconut milk after a long day cycling. Available as a golden brown coloured powered obtained from a turnip-like root vegetable native to the Andean mountains of Peru. It is classed as an adaptogen, i.e., it responds to your own body needs, and produces a response in the body, which increases your own ability to withstand stress. It appears to act to regulate your adrenal glands, the main organ within your body associated with coping with stress. When weighed down by the many stresses of modern life, the adrenal glands become overwhelmed and unable to cope. Maca helps to support the adrenal and restore energy, mental clarity and ability to handle stress. Buy as a powder.
Like maca, lucuma originates from Peru, being derived from the Peruvian lucuma fruit. Available in powdered form, it has a sweet maple syrup like flavour, which makes it a delicious sugar substitute that can be stirred into smoothies and used in puddings and cakes. It is rich in B vitamins, especially B1 and B2. Also high in fibre, other B vitamins, B3 and B5, beta-carotene, iron, potassium, calcium and phosphorous.
For an indulgent yet healthy comforting hot chocolate drink try Superfoodies Hot chocolate available from DetoxYourWorld.com, containing, organic cacao powder, lucuma powder and vanilla bean powder : £399 for a 100g packet)
Chlorella: a freshwater green algae, chlorella has amazing alkaline-promoting properties that help cleanse and detoxify your body, enhances your immune system, which may become low in times of stress, and helps build resilience. It is also extremely nutrient dense i.e., rich in beneficial nutrients, about 65% protein, containing all ten essential amino acids and rich in vitamins and minerals .
Buy as a power to add to smoothies and juices or part of any one of a number of green powders. For those trying for the first time, buying as part of a green powder mix is a good first step as it can be quite a distinctive taste that takes getting used to.
See Supercharged Smoothie recipe below.
Flax and Chai seeds
I have put these together as they share many qualities. I use one or other or both together. Chai seeds are smaller and do not require as much soaking as flax seeds. Best to buy ground flax seeds or else grind your own. Both are rich sources of fibre, protein, phyto-oestrogens (see Superfoods, part 1) and rich sources of omega 3, therefore especially good for vegetarians and those who do not like oily fish. Omega 3 helps reduce inflammation in the body, helping your body recover from the vigorous of exercise, and your body to burn fat as fuel, great if you are trying to loose weight and for athletes, since fat provides a longer and more sustained source of energy compared to carbohydrate.
Available to buy from most large supermarkets. See Chai Power Porridge recipe below
Vegetarian and vegan, hemp powder offers the most balanced amino acid profile of any of the plant-based protein powders. It also rich in the essential fatty acids, omega 3 and 6, high in fibre, vitamins and minerals. Like many of the other foods listed here, hemp powder also possesses anti-inflammatory properties, related to its omega 3 content.
2 tbsp chia seeds (available now from most supermarkets)
1 tbsp yoghurt (coconut or plan, bio yoghurt)
½-1 cup almond or coconut milk
Juice and zest of 1 orange
½ cup fresh berries or other fruit
Soak chia seeds overnight in the orange juice
In morning stir in the milk and pour into a serving bowl (or eat from container if at work)
Add yoghurt and sprinkle fruit and orange zest on top.
All ingredients to be as fresh and organic as possible
1 sticks celery
½ small pineapple
Handful of spinach leaves
¼ lime, peeled
4 golden delicious apples
½ ripe avocado
1 heaped teaspoon of Chlorella or green powder
Small handful of ice
Note: these comments are general in nature and individuals may respond differently. For a personalised consultation and advice please contact: Sam Moore at 07715 182474 or Dr Elizabeth Foot M: 07540 722236, E: firstname.lastname@example.org