Painkillers for low back pain

Many people use painkillers for low back pain. Some are freely available and several only on doctor's prescription. However, the latter are not innocent either: in 2007, 540 people died of painkillers in the Netherlands. If they still have to be used, which one is recommended?

 

Paracetamol (acetominophen) is of first choice. The reason for this is that: 1- the efficacy is comparable to others such as ibuprofen, naproxen, diclofenac sodium or acetylsalicylic acid, 2 side effects occur less frequently. This is evident from a PhD study from 2010. However, the size of the effect of painkillers for low back pain is not large and there may be differences per person. If paracetamol is used, the GP standard 'Aspecific low back pain' recommends 3 to 6 times daily 1 tablet of 500 mg or 3 times daily 2 tablets. This applies to adults. The intake must take place at fixed times and during a limited period.

 

Warning

Among the self-care medicines the painkillers, including paracetamol, are the most risky. 1% of users get a severe stomach bleeding, and more than 10% of this group die. Less well known is that some painkillers can interfere with other medications. For example, ibuprofen strengthens the effect of a number of anticoagulants/blood thinners. Diclofenac in combination with Prozac (fluoxetine) gives even more risk of gastric bleeding. A combination of painkillers also gives an increased chance of stomach bleeding. And so on. In the package leaflets you can find more information about side effects. These leaflets can also be found on the internet. If in doubt, consult your pharmacist or general practitioner.

 

Children

The warnings apply even more to children. This is because too little research has been done into the effective dose in children. There is another risk of underdosing: no effect, or overdose: more chance of side effects.

 

References
Roelofs P. Managing low back pain with lumbar supports and medication. 2010. ISBN 978-90-8659-423-8.

Bons SCS et al. NHG-Standaard Aspecifieke lagerugpijn (Tweede herziening) 2017.

Jeucken YM et al. Vrij verkrijgbare NSAID’s gebruikt door patiënten met contra-indicaties: een veilig idee? Huisarts Wet 2005;48(8):388-391.
Vonkeman HE. NSAID complications - the balance of risks. Thesis 2008.

Rodieux F et al. Safety issues of pharmacological acute pain treatment in children. Clin Pharmacol Ther. 2019 Jan 16. doi: 10.1002/cpt.1358.