Dr Michelle Dickinson: nanotechnologist on the non-surgical treatments that work for lower back pain

Lower back pain is something most of us have experienced at some point. Whether it's from sitting too long, lifting something heavy, or just the wear and tear of daily life, it's a common issue. But with so many treatments available, which ones actually work? A team of researchers set out to answer this question in a massive study published in BMJ Evidence-Based Medicine.

Gathering data from hundreds of previous studies, the researchers analysed 301 randomized controlled trials, covering 56 different treatments for low back pain. These treatments ranged from exercise and spinal manipulations to medications like NSAIDs (non-steroidal anti-inflammatory drugs) and antidepressants. 

To make the study even more precise, they divided the results into two categories: 

• Acute low back pain (pain lasting less than 12 weeks).
• Chronic low back pain (pain lasting 12 weeks or more).

Then, they compared each treatment to a placebo to see if it actually provided pain relief. 

The good news is that some non-surgical treatments do work, though not as dramatically as you might hope. 

For acute low back pain, NSAIDs (like ibuprofen) were the only treatment found to be effective, with a small but measurable pain reduction. 

For chronic low back pain, five treatments stood out: 

• Exercise: Physical movement tailored to strengthen the back and improve flexibility.
• Spinal manipulative therapy: Techniques often used by chiropractors to adjust the spine.
• Taping: Using supportive tape to stabilize muscles and joints.
• Antidepressants: Certain medications that seem to reduce pain perception.
• TRPV1 agonists: A class of treatments that target pain receptors.

Each of these treatments provided modest pain relief, meaning they worked better than a placebo, but not by much. 

What Doesn't Work?  

Some common treatments, surprisingly, did not provide significant pain relief. 

For acute low back pain, these treatments were found not to be effective: 

• Exercise (which works better for chronic pain but not short-term pain).
• Glucocorticoid injections (steroid shots that are sometimes used for inflammation).
• Paracetamol (acetaminophen) (commonly recommended but found to be ineffective in this study). 

For chronic low back pain, these treatments failed to provide significant benefits:

• Antibiotics (sometimes prescribed for infections that might cause pain, but no clear benefit).
• Anaesthetics (numbing agents that didn’t prove effective for long-term relief).

Many treatments had inconclusive results, meaning there wasn’t enough strong evidence to say whether they truly help. These included: 

• Acupuncture
• Massage
• Heat therapy
• Laser therapy
• Electromagnetic therapy 

This doesn’t necessarily mean they don’t work, just that more high-quality research is needed. 

So, if you have low back pain and are looking for non-surgical options, the research suggests: 

• If your pain is short-term, NSAIDs may help.
• If your pain is chronic, consider exercise, spinal manipulative therapy, taping, antidepressants, or TRPV1 agonists.
• Some treatments commonly recommended (like paracetamol and steroids) might not be as effective as previously thought.
• Many alternative treatments show promise but need better studies to confirm their benefits. 

See omnystudio.com/listener for privacy information.

Episode Transcript

Speaker 1 (00:06):
You're listening to the Sunday Session podcast with Francesca Rudgin
from News Talks.

Speaker 2 (00:11):
It'd be doctor Michelle Diikinson is with us now with
the science study of the Week, and I think you've
got one that will really resonate with a lot of
our listeners. We're going to talk about lower back pain,
something that so many people suffer from, more issues worth.

Speaker 3 (00:26):
So many people have it, and when you have it,
you know how it can stop almost everything in life.
You just can't get out of bedprop with, you can't
do normal things, and the question is what do you do?
And if you go to the doctor. What this study
found is that doctors prescribe very very different things because
we haven't really put together a study going what works,
what doesn't work, what should you do immediately? That's why

(00:48):
the study is great. So it is published in BMJ
Evidenced May Based Medicine BMG Evidence based Medicine. It iss
open source, so feel free to go. Is a very
easy read and go and have a look at it
if you do stuffer from lower back pain and you
want to read into this more so. What they did
is they took three hundred and one different clinical trials

(01:10):
that looked at fifty six different treatments. They looked at
who was prescribing them, what doctors were suggesting, what the
most common thing was, and said, these are actually the
ones that we can see work when compared against the placebo.
These are the ones you shouldn't waste your money on,
and these are the ones that we couldn't tell we
need a bit more research on. So, if you do

(01:30):
have lower back pain, you have one of two types.
One is acute, which is where it's suddenly come on
and you have it for less than twelve weeks, typically
an injury or something you've done, you know, you twisted
your back. Two is chronic, so that's classes you have
lower back pain for more than twelve weeks as an
ongoing thing that's happening around it. So they decided this
study into acute and chronic back pain, and they compared

(01:54):
all of the treatments. And so, if you have acute
back pain, you've just tweaked your back, you've just woken up,
you're like out. That really hurts. The thing that they
say that really works, evidence based and it's really simple
and really cheap, is ibuprofen. Just some pine relates literally ibuprofane.
Now not any type of pain relief. So ibuprofene is

(02:16):
about being anti inflammatory. It's called a nonsteroid or anti
inflammatory drug. So something that is NSAIDs is what they're called,
but you would know it as ibuprofen that actually is
reducing the inflammation. The reason why I say that is
because when they looked at the effect of paracetamol, it
didn't have the same So just take some ibuprofene, rest

(02:38):
it a little bit, go see you're dark. But that's
going to be the thing that actually works. And what
they found that doesn't work with a cute back pain
is exercise. Because the chances are you've just tweaked something,
your muscles are all going to be spasmed up, everything's
going to be really tight. If you go, oh, I'm
going to go do some exercise. Now, sometimes that can

(02:59):
cause more problems. And they found that it doesn't help
with short term pain relief. So it's not after that
I say don't exercise. This is the one that says,
if it's a cute just layer for it. Just rest
your back, take some ibutprofin. The other thing that they
found didn't work is a steroid shot. So sometimes doctors
will give you a steroid shot into your back to
try and reduce that information. They found that actually for

(03:22):
acute information and acute back pain, it doesn't work. All
don't take that risk, don't do it. So we're going
to move from there to the chronic pain. So if
you have chronic pain, you've had back pain for more
than twelve weeks, it's a constant thing. The things that work.
There were five treatments that they found really worked. Number
one exercise, so this is what you should do. Strengthen
your back, increase your flexibility. Although it's painful, it really

(03:44):
is going to help you over the long run and
it's going to and reduce the pain. Number Two taping,
So if you go to a physio and they tape it,
what they do sometimes is isolate certain muscles to take
the stress off. Taping definitely helps from a physio if
you have chronic back pain. Number three spine or manipulation
therapy chiropractice. I never thought they'd say this, butpractors actually

(04:07):
the way that they can manipulate your spine. They found
that if you have chronic back pain, really can relieve
some of the pain and take the pressure off. So
that's your physio, that's your chiropractor, and making sure you're
doing exercise. Now, things that you might have to go
for a prescription for is They found some antidepressants reduce
pain perception, and if you are having long term back pain,
anti depressants might be something you need to help you

(04:28):
mentally deal with that. And they also found that TRPV
one agonists, which is a specific type of drug that
targets pain receptors, actually are very good at reducing that.
So that's what you do with chronic What they found
that was being prescribed for people with chronic pain that
didn't help was antibiotics. Contactors were prescribing antibiotics because they
thought that infection might be caused as pain. Yeah, don't

(04:51):
do that. And these robot anesthetics, you know, you get
these creams and things like numb it. They were like, yeah,
you just basically just end up smelling of this like
really hurple thing. But it's not gonna work, so not
for long term pain relief. So that's they found. Now,
what they found inconclusive, and this might help fancy your
question before, is and it just means that they need

(05:12):
more research. It doesn't mean it doesn't work or it
does work. They couldn't tell anything about acupuncture. They're just
isn't enough research on ancupucture, massage, therapy, physiotherapy, some of
those things around back pain need more research. Heat therapy again,
couldn't tell laser therapy and electromagnetic therapy. They're like, hey,
we know they're out there, we just couldn't make the
decisions in the data that we had. That's interesting, So

(05:33):
more research needed. But basically, if you've got a cute
back pain, you've just done it. Take some ibuprofen, just
dress for a little bit. If you've got chronic back pain,
do some exercise, keep moving, keep moving, and so treat
them differently. And it's a lovely study. So BMJ Evidence
Based Medicine. If you do have low back pain, have
a read and yeah, you can do some things about it.

Speaker 2 (05:53):
Thank you so much, Michelle.

Speaker 1 (05:54):
We'll catch up next week for more from the Sunday
session with Francesca Rudken. Listen live to News Talks it'd
be from nine am Sunday, or follow the podcast on iHeartRadio.