Can you really get off the pain medications for your back and spine pain? How?

Ross A. Hauser, MD., Danielle R. Steilen-Matias, MMS, PA-C

Can you really get off the pain medications for your back and spine pain? How?

When someone comes into our office with back pain, they have a lot of fear. They have fear of surgery, they have a fear that they are taking too many medications, they have fear of disability, they have fear of motion and moving because that may cause them a lot of pain and make their back seize up. They will also tell us that we don’t understand how necessary the continued use of prescription medications is to manage their back pain.

This is not true, we do understand the strength of this person’s desire to remain on these medications. We also know that they have a strength of desire to get off off these medicines. We have been helping people with back pain for over 28 years. Life has brought these people a very demanding challenge, one of significant, life-altering back pain. Yet they have to manage.

Some of these people are construction workers or others who have very physically demanding jobs. To them, the only way they can work is by using pain medications. They are very fearful that if they do not take the medications, they will have too much pain and they cannot work. Some are people that have to sit all day and they have to alternate between painful sitting, painful standing, and very painful getting out of a chair.

We understand these challenges, however, we do see a different way to help these people. Instead of pain medications, we help restore pain-free function to the spine. In our clinics, we use regenerative medicine injections to strengthen the soft tissue attachments of the spine. This helps bring the vertebrae back into alignment, reduces pressure on nerves and discs, and reduces and in many cases eliminates pain on a long-term basis. Our treatment restores function. Since 1993, we have been practicing this functional regenerative medicine instead of pain management and prescription writing.

We do know that many people who are reading this article, are not the people are suffering from back pain themselves. Rather, many of the people reading this article are a spouse, a son, a daughter, or a loved one who is very concerned that their loved one is on these pain medications. We hope we can give you some good information to help your loved one.

Research: Functional medicine vs pain medicine, 2019

Moving away from pain management medicine as a primary treatment recommendation due to the limited effectiveness and the risk of adverse effects

In February 2019, in the journal Expert Review of Clinical Pharmacology (1) a team of doctors from Erasmus MC, University Medical Center, the University of Southern Denmark and the University of Sydney examined the standard of care in the pharmacological treatment of non-specific low back pain with recent studies used as the best available evidence on drug efficacy and common adverse effects.

What they found was that new research was universally moving away from pain management medicine as a primary treatment recommendation due to the limited effectiveness and the risk of adverse effects.

• NSAIDs have replaced paracetamol (Tylenol) as the first choice analgesics for non-specific low back pain in many guidelines. Please see our article When NSAIDs make pain worse.
• Opioids are generally considered to be the last resort, but opioid prescriptions have been increasing over recent years.
• Upcoming guideline updates should explicitly shift their focus from pain to function and from pharmacotherapy to non-pharmacological treatments; patient education is important to make sure non-specific low back pain patients accept these changes.

The learning points of this study:

• Doctors are moving away from pain management to functional management.
• This is especially true for non-specific low back pain. Where your primary care or specialist cannot truly pinpoint the origin of your pain and the only way to treat it is with pain management medications.
• “Patient education is important to make sure non-specific low back pain patients accept these changes.”

At the beginning of this article, we said: “someone will tell us that we don’t understand how necessary their continued use of prescription medications is to manage their back pain.” This research team above said: “Patient education is important to make sure non-specific low back pain patients accept these changes.” Accepting a change to functional, repair medicine and away from pain management may be hard for some people. Unless you show good results and your functional treatment takes the person’s pain away.

In November 2018, Swiss researchers from the University of Zurich and the University Clinic for General Internal Medicine in Bern published their review of recommendations for patients with chronic low back pain. The learning points of their study, published in the journal Internist (2)  suggests:

• Pain medications can support non-pharmacological measures and improve physical function. (This would include exercise and therapy).
• There are hardly any studies on the effectiveness of many pain medications. Yet they are prescribed.
• Most studies surround the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs) however, potential adverse effects and contraindications for NSAIDs need to be taken into account when the medication is prescribed.
• For other non-opioid medications (e. g. paracetamol (Tylenol), metamizole (dipyrone)) the effectiveness of these medications is not well studied.
• Weak and strong opioids have been shown to be effective compared to placebo in the short term; however, there is increasing evidence that opioids are no more effective than non-opioid medications in the treatment of acute and chronic low back pain.
• Furthermore, gastrointestinal and central nervous system adverse effects of opioids should be considered.

The conclusion of this study cites: “The main goal of pain medications is to enable patients to stay active.” This is what we call functional medicine.

Why am I getting an antidepressant for my back pain? Because if the only other choice is an opioid, the anti-depressant is better

In November 2018, an international team of researchers led by Monash University in Australia published these findings in the Journal of the American Medical Association (3) (JAMA)

Here are the learning points of their research:

• Antidepressants at low doses are commonly prescribed for the management of chronic low back pain and their use is recommended in international clinical guidelines. However, there is no evidence of their effectiveness.
• This study suggests that amitriptyline (an anti-depressant sometimes given to help with insomnia or sleep disorders) may be an effective treatment for chronic low back pain.
• However, there were no significant improvements in outcomes at 6 months, but there was a reduction in disability at 3 months, an improvement in pain intensity that was nonsignificant at 6 months, and minimal adverse events reported with low-dose, modest sample size, and active placebo.
• Although large-scale clinical trials that include dose escalation are needed, it may be worth considering low-dose amitriptyline if the only alternative is an opioid.

Function and pain management – what is the reality you can move off of pain medications?
Our published research on getting 75% of patients off their pain medications

Citing our own Caring Medical published research in the Journal of Prolotherapy (4) which we followed 145 patients who had suffered from back pain on average of nearly five years, we examined not only the physical aspect of Prolotherapy but the mental aspect of treatment as well.

• In our study, 55 patients who were told by their medical doctor(s) that there were no other treatment options for their pain, and a subset of 26 patients who were told by their doctor(s) that surgery was their only option.

• In these 145 low backs,
  • pain levels decreased from 5.6 to 2.7 after Prolotherapy;
  • 89% experienced more than 50% pain relief with Prolotherapy;
  • more than 80% showed improvements in walking and exercise ability, anxiety, depression and overall disability
  • 75% percent were able to completely stop taking pain medications.

If our study, mentioned above, was solely based on getting 75% of patients off their pain medications, that would be wildly successful in itself. But the fact that Prolotherapy was able to strengthen the patient’s spines and decrease overall disability and return these people to a normal lifestyle. That is not pain management, that is a pain cure.

If this article has helped you understand the role of pain management and functional medicine procedures and you would like to explore treatment options, get help and information from our specialists

References:

1 Schreijenberg M, Koes BW, Lin CW. Guideline recommendations on the pharmacological management of non-specific low back pain in primary care–is there a need to change?. Expert review of clinical pharmacology. 2019 Feb 1. [Google Scholar]
2 Wertli MM, Steurer J. Pain medications for acute and chronic low back pain. Der Internist. 2018 Aug. [Google Scholar]
3 Urquhart DM, Wluka AE, Van Tulder M, Heritier S, Forbes A, Fong C, Wang Y, Sim MR, Gibson SJ, Arnold C, Cicuttini FM. Efficacy of Low-Dose Amitriptyline for Chronic Low Back Pain: A Randomized Clinical Trial. Jama internal medicine. 2018 Nov 1;178(11):1474-81. [Google Scholar]
4 Hauser RA, Hauser MA. Dextrose Prolotherapy for unresolved low back pain: a retrospective case series study. Journal of Prolotherapy. 2009;1:145-155. [JOP/CMRS]

1586

• Surgery
• NSAIDs
• Cortisone Shots
• R.I.C.E.