Basis, indications and risk: Pharmacological therapy

Treatments Basis, indications and risk Patient information Postural hygiene Exercise Maintaining level of Activity Bed rest Pharmacological therapy Analgesics Non steroideal antiinflammatory drugs Muscle relaxants Other Neuroreflexotherapy (NRT) Spinal column surgery Surgery for Pain and Pain Clinics Vertebral manipulation Behavioral treatment Epidural injections Facet joint infections Trigger point and ligament infections Rhizotomy Corsets and lumbar belts Traction Physical therapy/physiotherapy Electromyografic Feedback TENS: Transcutaneous electrical Nerve Stimulation Shoe insoles and shoe lifts Acupunture Recommended treatments

Non-steroid antiinflammatory drugs (NSAIDS)

Objective

To decrease the inflammation complicating most back pain.

Theoretical basis

The onset of inflammation is due to the release of different molecules. Non-steroid antiinflammatory drugs basically act by hindering the production or release of these molecules.

Evidence of efficacy

There are many studies proving the effectiveness of non-steroid antiinflammatory drugs to reduce pain and mobility limitations present in acute episodes of back pain. The existing evidence-based recommendations establish that, although frequently prescribed along with muscle relaxants, this combination has not proven to produce a better effect than each component on its own.

The existing evidence-based recommendations recognize the efficacy of antiinflammatory drugs to improve back pain and state that the different types of these drugs have a very similar rate of effectiveness. The recommendations also note that these drugs are more effective in treating back pain than radiated pain.

Risks and side effects

When taking a non-steroid antiinflammatory drug orally, by suppository, or by intramuscular injection, the medication is introduced into the blood and is distributed throughout the body. The portion that finally reaches the structures involved in back pain may cause improvement, but the remaining portion that has reached other parts of the body is useless and may produce adverse effects.

Adverse reactions are specific to each type of drug and are detailed in the package inserts of the pharmaceutical product. The most frequent adverse effects are digestive tract disorders which range from heartburn to bleeding ulcers and, less frequently, kidney damage.

The longer a pharmacological drug is used, the less its rate of effectiveness and the greater the risk of side effects. Therefore it is important to follow your physician's recommendations precisely.

Do not use drugs that have previously caused allergies, nor those not prescribed by your physician.

Recommendations

The use of anti-inflammatory drugs is recommended to ease the intensity of symptoms during the periods of acute pain or during crises or chronic pain exacerbation. They are the most widely used pharmaceuticals in these cases.

In general, with exceptions, they should not be used during more than 14 consecutive days to avoid risk of adverse effects.