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Pain Medication and injections
Tags: back pain, back pain management, back pain relief, chronic pain, chronic pain relief, low back pain, Low back pain relief, low back pain treatment, physical therapist Prescott, Prescott physical therapy
It might be time for you to rethink pain medications and injections for addressing musculoskeletal pain.
Western medicine has evolved to the point that pain, any kind of pain, is addressed FIRST with drugs and/or injections. Most complaints of pain are musculoskeletal in nature, meaning the pain generator is muscle or joint related. A recent research paper released in January 2013 by the Mayo Clinic shows that the second and third most common reasons for a patient to visit a physician are osteoarthritis/joint disorders and back pain, respectively (1). So the second and third most common reasons for all physician visits are PAIN. The first line of defense to treat pain has traditionally been medication. This can be in the form of NSAIDS (anti-inflammatory medications), muscle relaxers, or opioids (pain killers). The second line of defense, if pain is persistent and still felt following a course of medication, is often cortisone injection. Let’s discuss the medications first and then move on to injections.
NSAIDS (non steroidal anti-inflammatory drugs) are extremely common and can be purchased across the counter. Ibuprofen is probably the most well known over the counter NSAID. Common prescription NSAIDS include Celebrex and Naproxen. While NSAIDS do decrease inflammation and are effective to manage acute musculolskeletal pain, there is quite a bit more going on with these drugs. Here some facts taken from medical journals:
- 107,000 patients are hospitalized annually for NSAID related gastrointestinal complications.
- Approximately 16,500 NSAID-related deaths occur each year in arthritis patients alone.
- If deaths from gastrointestinal toxic effects were figured separately, these deaths would rank as the 15th most common cause of death in the United States.
- Major adverse gastrointestinal events due to NSAIDS are responsible for over 100,000 hospitalizations and $2 billion in healthcare costs each year in the U.S.
Considering these facts, ask yourself how prudent it is to pop ibuprofen or any prescription anti-inflammatory like candy. While you probably won’t have any problems, these drugs are not exactly healthy. They are certainly not meant to be taken long term, though they often are. I recommend not taking these drugs daily for more than two consecutive weeks. How it has become normal to use these drugs like you’re drinking water is beyond me. If there was a food that boasted the track record of NSAIDS, it would be outlawed. Think about it. Nobody would chose to eat food regularly for months or years that had these dire statistics. We eat NSAIDS daily for years on end, then get bleeding ulcers and can’t figure out why. When asking patients if their NSAID or pain medication helps, over half of them answer with ‘kind of’, ‘not much’ or ‘no’, in that specific order. With that being said, you should reconsider how you use these drugs.
Muscle relaxers result in decreased muscle tone. They do not decrease pain directly. Unless you have considerable muscle spasms in your back or neck, there is no reason to take muscle relaxers.
Pain pills or pain killers are generally opioids. These drugs include Percocet and Vicodin among many others. Originally opioids were reserved for use with patients who had cancer related pain or pain at the end of life. Since the 1990’s, these drugs have been prescribed for arthritis, back pain, and migraine headaches. They became more widely prescribed in an effort to aggressively treat pain. It really hasn’t panned out so well. Overdoses involving prescription painkillers kill more Americans than heroin and cocaine combined. Back pain? Here take this. It kills more people yearly than cocaine and heroin. No big deal.
We spend billions of dollars yearly on the “war on drugs,” then turn around and give everyone with any complaint of pain, drugs that are just as dangerous as those that are illegal. Brilliant. There is a place for these drugs, clearly. Run of the mill mechanical low back pain is NOT one of these places. Nor is knee pain, hip pain, or shoulder pain. Do a google search for painkiller addiction. It’s referred to as an epidemic. It is literally out of control. Is it really necessary for someone with a backache or neck pain to be prescribed these drugs? No, it’s not. Seriously, just because it has become common practice and is part of society doesn’t mean that it is necessary, okay, or even safe. I could continue on, but the statistics and a google search will suffice.
On to injections. We will look at tennis elbow (pain felt along the outside part of your elbow) and low back pain specifically. The most recent research shows that cortisone injections for tennis elbow increases the rate of continued problems one year out as compared to not receiving a cortisone injection. Why would you even consider an injection for tennis elbow pain (which is common) when research shows that people who have the injection have an increased rate of recurrence? I don’t know why either. If you were aware of that research, you probably wouldn’t ask or agree to the injection.
As for low back pain, how many of you have had epidural steroid injections or at least talked to people who have? Epidurals are very common in patients over fifty years of age who have low back pain with or without leg pain. A recent study published in Spine shows that patients treated with epidurals had significantly less improvement at the 4 year follow up compared to other patients with spinal stenosis. In addition if surgery was performed, patients who had undergone epidural steroid injections had a longer duration of surgery and a longer hospital stay. It is possible that patients who underwent epidurals were worse off to begin with, but even if this is the case the injections certainly did NOT improve their conditions. This is not the only study showing that epidural steroid injections may not be effective, and could even be detrimental, for patients with low back pain. Epidurals have been shown to be no better compared to placebos for patients with low back pain.
Are epidurals even necessary and why are they done?
Would you seek out or agree to an epidural steroid shot if you knew the facts? Doubtful, especially considering this disaster.
To be clear, there is a place for pain medication and anti-inflammatories. They are just not a long term solution and the cost/benefit ratio must be considered. Also I’ve had patients with low back pain and tennis elbow who have benefitted from injections, but the medical research evidence shows injections are NOT effective most of the time for most people. The point is, these options that have become the standard of care are truly not the best options because they usually DON’T work! “What else is there?” you ask. In the next article I will give you five alternatives to medication and/or injections without the side effects.