Chapter

Pharmacotherapy of Low Back Pain

Kay Brune and Bertold Renner

in From Acute to Chronic Back Pain

Published on behalf of Oxford University Press

Published in print January 2012 | ISBN: 9780199558902
Published online November 2012 | e-ISBN: 9780191753343 | DOI: http://dx.doi.org/10.1093/med/9780199558902.003.0134
Pharmacotherapy of Low Back Pain

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It becomes clear that LBP is and will remain a major health problem. There is little proven evidence of the therapeutic effects of many drugs and other treatments (Bouwmeester et al. 2009). In ALBP, only COX inhibitors, used cautiously, may help to regain mobility and social functions (Kroenke et al. 2009) which in turn allows for exercise that furthers recovery (Oesch et al. 2010).

As COX inhibitors lose effectiveness with time, opioids may step in. Their effect may be enhanced by co-medication with either muscle relaxants or antiepileptics. However, opioids + muscle relaxants or antidepressants show a high rate of UDEs. Most patients find these side effects intolerable which leads to a dropout-rate (in studies) around 50% (Kuijpers et al. 2010).

Obviously, the treatment of CLBP requires therapeutic planning and long-term therapy, including psychotherapy and physiotherapy as main pillars whilst the different drugs may be regarded as auxiliary.

The biggest problem is the inability of many patients to cope and wait. Some resort to remedies of unproven or even disproven value (effect), as herbal medicines, local steroids, topical non-steroidals, acupuncture, an injection therapy using steroids, etc., and surgical interventions. Whilst the former are unlikely to harm the patient seriously, attempts to inject into the fine zygapophysial joints and surgical interventions in patients who have no hard indication (nerve decay and paralysis) may add to the negative long-term outcomes of LBP.

Chapter.  5956 words.  Illustrated.

Subjects: Neuroscience ; Pain Medicine

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