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Muscle relaxants and opioids offer no extra relief for low back pain, study finds

Opioids are frequently prescribed — often along with muscle relaxants and over-the-counter pain relievers — to people with moderate to severe low back pain.

An over-the-counter pain medication provides as much relief for severe lower back pain as a prescription muscle relaxant or a prescription opioid painkiller, according to a study published this week in the Journal of the American Medical Association (JAMA).

As a pain expert not involved in the study told HealthDay reporter Steven Reinberg: "This is another study to add to the pile that says narcotics are not appropriate to treat back pain.” 

Back pain is one of the most common ailments in the United States. In any three-month period, about one-fourth of adults experience at least one day of back pain, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

Back pain is also the cause of 2.7 million visits to U.S. hospital emergency departments each year.

Opioids are frequently prescribed — often along with muscle relaxants and over-the-counter pain relievers — to people with moderate to severe low back pain. No high-quality evidence supports the effectiveness of opioids for the treatment of low back pain, however, and muscle relaxants have been found to provide, at best, only short-term relief.

In addition, the use of opioids for treating pain other than that associated with cancer has become highly controversial. During the past decade, overdose deaths from prescription painkillers have skyrocketed, leading the Centers for Disease Control and Prevention to declare prescription drug abuse the fastest-growing drug problem in the country.

Every year, more than 16,000 Americans — an average of 44 people each day — die from overdoses of prescription opioid painkillers, according to the CDC.

Study details

For the current study, a team of researchers at the Albert Einstein College of Medicine in New York City followed 323 patients, aged 21 to 64, who sought care at the emergency department of the college’s hospital (Montefiore Medical Center) for symptoms of severe low back pain. Patients were excluded from the study if they had been experiencing back pain for longer than two weeks or if they had a history of using opioid painkillers.

All the patients were sent home from the hospital with instructions to take 500 milligrams of the over-the-counter pain reliever naproxen twice a day. The patients were also randomly divided into three groups. One group was assigned to take (in addition to the naproxen) the muscle relaxant cyclobenzaprine, another to take the opioid oxycodone, and the third to take a placebo. They were instructed to take these additional drugs every eight hours as needed. 

The patients were also given a 10-minute educational session on self-treatments for low back pain, including instructions on the use of hot and cold packs and on exercises and stretches that might help alleviate symptoms.

Key findings

The patients were interviewed one week and three months after their visit to the emergency department. They were asked whether their pain or their ability to physically function had improved. They were also asked about their use of the medications they had been prescribed.

At the one-week mark, no differences were found among the three groups. About two-thirds of the patients in each group said their pain had improved, and about half said they still had some functional problems. More than half of the patients in each group also said they were continuing to take the pills that had been given to them.

Three months later, the reports from the three groups were also quite similar. One-fourth of the patients in each group still said their pain was significant enough to require continuing their medication.

Adding either the muscle relaxant or the opioid to naproxen “did not improve functional outcomes,” the study’s authors conclude. “These findings do not support the use of these additional medications in this setting.”

“Emergency physicians [and, presumably, other physicians] should inform their patients that passage of time is likely to bring improvement and eventual relief to most patients,” they add.

You’ll find an abstract of the study on the JAMA website, but, unfortunately, the full study is behind a paywall. For information on what you can do at home to relieve — and prevent — low back pain, go to the NIAMS website.

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Comments (1)

Its not about the pain

Its about not caring about the pain. Take enough of these pain meds and you just don't care.