Ibuprofen (NSAIDs), Tylenol, and Opioids Don't Help Back Pain

Tylenol no help for back pain recovery

NSAIDs like Ibuprofen, Tylenol, and opioid medications have commonly been used to relieve back pain for years, but recent studies on effectiveness have surprised doctors by finding little benefit to these medications.

You know what they say about assuming...

Ibuprofen and Tylenol have been assumed to be first-line treatments for back pain, but few doctors or patients knew there has been little research to support their effectiveness. Opioids have similarly been assumed and promoted as a good option for severe back pain, but had not been well researched. Now the studies are out on all three forms of medication, and the results are not good. 

Tylenol no help for back pain recovery

Researchers performed a controlled trial for Tylenol and back pain with over 1500 patients across 235 primary care centers from 2009 to 2013. The use of Tylenol daily and as needed for back pain was compared to placebo pill. The placebo group on average actually recovered slightly quicker than the Tylenol groups. The researchers concluded: "Our findings suggest that regular or as-needed dosing with [Tylenol] does not affect recovery time compared with placebo in low-back pain, and question the universal endorsement of [Tylenol] in this patient group."

Ibuprofen no better than sugar pill

After Tylenol failed to show effectiveness for back pain, researchers reviewed 35 randomised placebo-controlled trials (RCTs) looking for evidence of NSAID (Ibuprofen and others) effectiveness for back pain.  They struck out again. NSAIDs only reduced pain and disability as much as placebo, but provided clinically unimportant effects over placebo. Researchers concluded: "The magnitude of the difference in outcomes between the [NSAIDs] and placebo groups is not clinically important. At present, there are no simple analgesics that provide clinically important effects for spinal pain over placebo."

Opioids = strike three. Little benefit. High Risk.

It's hard to believe the death toll opioids have caused when there hasn't been thorough study of their effectiveness for back pain, but that is the case. Once again, researchers reviewed 20 RCTs of opioid analgesics (with a total of 7925 participants) and 13 trials (3419 participants) evaluating short-term effects on chronic low back pain. There were no RCTs for acute back pain. In half of the 13 trials, at least 50% of participants left the study due to side effects or lack of efficacy, and relief was so little it was "not clinically important." The researchers concluded that those who can tolerate opioids may see a little short-term pain relief, but it is not significant. "Evidence on long-term efficacy is lacking. The efficacy of opioid analgesics in acute low back pain is unknown."

What treatment is best for back pain?

The American College of Physicians (ACP) back pain guidelines recommend first using non-invasive, non-drug treatment like chiropractic spinal manipulation before resorting to drug therapies for pain. Other non-drug treatments like acupuncture, exercise therapy, heat, and massage can also be helpful. These non-drug treatments can be just as effective, and in some cases more effective than medications like Tylenol, Ibuprofen, and opioids without the risks and  dependency. Never start with opioids, and think twice before reaching for Tylenol or Ibuprofen first for pain.

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