Long-term NSAID, Steroid Use May Prolong Back Pain Instead of Treat It: Study

Researchers say by reducing early inflammation, NSAIDs and steroids may actually cause pain to become chronic.

According to the findings of a new study, the use of Advil, Motrin and other common painkillers to treat lower back pain may actually cause the pain to last longer.

Ongoing use of steroids and painkillers, including non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can cause pain to continue far longer than it would have if someone had not taken the painkillers, and can lead to chronic pain, according to a report published this week in the journal Science Translational Medicine.

Researchers from McGill University in Canada focused on pain and the transition to chronic pain and the role the immune system may play. They conducted patient observations, analysis of patients from a large database and animal studies.

The study looked at blood markers that indicate which patients would have pain that quickly subsided and those that would have chronic pain. They took blood samples from 98 participants when they first began developing back pain and again three months after the pain began.

Those who reported the pain went away had intense inflammation when the pain was at its worst. However, the inflammation markers subsided over the next three months. Participants who had pain that continued did not have the inflammatory reaction early on.

The researchers also conducted experiments with mice, finding that when they gave some mice a prescription NSAID, diclofenac, while other mice received an analgesic like morphine, lidocaine, or gabapentin, all pain-relieving drugs. Mice who received the steroid had pain that turned into chronic pain.

Follow-up experiments led the researchers to determine patients taking an NSAID had double the risk of developing chronic back pain compared to those taking other drugs or no drugs at all.

Researchers said the tendency for doctors to prescribe NSAIDs in lieu of opioid painkillers continues, despite the less than effective performance of this class of drugs. While opioids prescribing carries concerns of addiction and abuse, they are often effective where NSAIDs are not. The researchers noted NSAIDs have nearly no benefit compared to placebo in treating low back pain, the most common type of pain according to the Centers for Disease Control and Prevention.

Other research has shown exercise, physical therapy, heat and massage are as effective as painkillers without the same side effects. The medical motto is, if it hurts, take a painkiller, NSAID, or steroid, but that does not heal the patient, the researchers warn. It suppresses inflammation and according to the results of this new study, allows the pain to persist in the long-term.

Some medical experts urged caution, since the study was a double-blind clinical trial involving a placebo, the gold standard of scientific research, and say further research is needed to confirm the findings.