Acute low back pain is a very common problem, so one would think that we would already know how to treat it optimally. Sadly, we don’t.
A study in this week’s Lancet raised serious doubts about two of the most common therapies sought out by patients with low back pain: non-steroidal anti-inflammatory drugs (NSAIDs) and spinal manipulation. The study received much coverage in the general media including this US News article.
The study enrolled 240 patients with acute low back pain. All the patients received advice from a physician to take acetaminophen (the ingredient in Tylenol) four times a day and to remain active. They were then randomized into four groups. One group received diclofenac (an NSAID, similar to ibuprofen and naproxen) and spinal manipulation. A second group received spinal manipulation and placebo pill. A third group received diclofenac and sham spinal manipulation. The last group received the placebo pill and sham spinal manipulation. All four groups recovered from their back pain at the same rate.
So the best advice for acute low back pain is to take acetaminophen four times a day and to stay active. The manipulation and stronger pain medicine may make you feel like you’re getting more care, but you won’t get better any sooner.
It’s humbling to find out that what physicians do is frequently useless, but it’s better than not knowing.
Since we’re in flu season, several patients have asked me about the safety of thimerosal, a mercury containing preservative in some formulation of the flu vaccine. The CDC has a very helpful Q&A page about it.