back to article Bad back? Show some spine and stop popping paracetamol

The human spine is poorly-designed for the rigours of modern life, but so are the drugs most commonly prescribed to help you endure a bad back. That's the conclusion of a new study looking into whether paracetamol, the drug most often suggested to treat bad backs, actually helps. Reported in The Lancet, the study funded by …

  1. MrDamage

    Gunja Works

    Although I'm not sure if it actually lessons the pain, or you just stop giving a shit about it.

    1. Nigel 11

      NSAIDS

      Ibuprofen, Naproxen, Diclofenac and dozens of other prescription drugs are NSAIDs: non-steroidal anti-inflammatory drugs. They relieve pain caused by inflammation, by reducing the inflammation. As a gout sufferer I know that large doses of these drugs are spectacularly successful on the right sort of problem. Crippling agony to mild ache in six hours. Magic that works!

      But if you have back pain, it may very well be neurological: a trapped or pinched nerve. In which case an anti-inflammatory drug is useless. Which leaves Paracetamol, Aspirin and the all-too-addictive opiates.

      Personally, the only thing I've found Paracetamol any use for is flu / bad colds (and I do wonder whether palliative interference with the natural self-curing of these ailments is wise) I used to find Aspirin much more effective, except it's contra-indicated for gout sufferers like me. Aspirin has a direct effect at the neurological level, as well as being an anti-inflammatory drug.

      Another reason to avoid NSAIDs for back pain is that it's likely to be chronic, and long-term use of anti-inflammatories is rather bad for you. They appear to block your body's natural repair mechanisms, and if you take them long-term your risk of suffering a stroke or heart attack slowly rises. In some people they also cause stomach bleeding, which long-term can lead to ulcers or anaemia.

      1. phil dude
        Pint

        Re: NSAIDS

        I can literally feel my liver complaining when I have taken paracetamol...

        https://en.wikipedia.org/wiki/Paracetamol_toxicity

        Beer might well be better for you...

        P.

      2. Eddy Ito

        Re: NSAIDS

        For those who may not be aware, paracetamol is acetaminophen in North America.

        Back pain is particularly difficult because it has so many different causes so there is no universal cure all pill to take. I've been lucky most of my back problems have been associated with muscle spasms and I've found a bit of torture massage, while painful, does wonders is short order and muscle relaxers also work reasonably well although it frequently tightens up again later. As for the various pain relievers they seem to relieve my wallet more than my pain.

      3. Vic

        Re: NSAIDS

        As a gout sufferer I know that large doses of these drugs are spectacularly successful on the right sort of problem.

        I've had 2 gout attacks now.

        Hydration is everything. I was dehydrated on both occasions, and rehydration sorted the problem out in double-quick time.

        Ibruprofen worked in the short term, though :-)

        Vic

    2. Tsunamijuan

      Re: Gunja Works

      I have found that for certain types of pain, Like nerve pain. Weed will actually increase the pain in some situations. If you have something that is more mellow and less extreme level of hightening senses its more likely to help you relax and deal with the pain. Generally it works best when mixed with a light doseage of an opiate to increase the relaxation effect. As one of the worst things about chronic pain is that it often become very difficult to escape from. Which can result in your body sometimes having problems like complete inability to think, or perform simple tasks. Cause its just so overloaded by pain.

      Then again one of the keys to not becoming addicted to opiate based pain killers isn't to get rid of the pain completely. Cause often if your completely getting rid of the pain all the time, you are significantly over medicating and increasing your tolerances. If you can treat your pain to a point where you can function enough to stay focused and live your life that is generally the best level to be at. That and when your experiences time periods where you are possibly in a lower level of pain to cut back on pain killers. Instead of just continuing to take them every 6 hours on that schedule that becomes almost a routine that you don't think about.

  2. Gray Ham

    Nothing works faster ...

    ... so take nothing.

    1. big_D Silver badge

      Re: Nothing works faster ...

      Yep, I've tried paracetomol, ibuprofen, cocodamol, diclofenac and the other usual suspects, at prescription levels. None have even dented my back pain, at best they make me sleepy at worst I get side effects.

      Last time I needed a cortisone injection, that was the second injection, the first injection the day before was a normal pain reliever (I can't remember the name) and had absolutely no effect.

      The next step up is opiates, but that isn't somewhere I want to go, so I suffer with the back pain most of the time.

      1. Gray Ham

        Re: Nothing works faster ...

        @Big_D

        You have my sympathy ... it must be damned hard to live with. ln my case, I am very fortunate that the chronic pain is my knee and ankle rather than my back: I can live with it and manage it with exercise.

        Paracetamol, I have found, is completely useless for pain relief (including the special strength marketed for arthritis) - though, I sometimes use ordinary aspirin, which seems to have more effect. Also use a traditional Chinese liniment that seems to help (yes, I'm aware it may be a placebo, but it works for me).

        1. Richard Jones 1
          Pint

          Re: Nothing works faster ...

          I lived with the pain for ten plus years and took industrial levels of Dicloflex to no effect. I was even on Viox for a short time, what a story that came with: drug test data, it appears you might as well make it up.

          When the pain got worse I graduated to Tramadol but then two and a half years ago I had a proper scan. I found out the I had a real problem that could be solved by a real action, (and it had better come quickly by that stage or I would have been in very serious problems with lower limb and organ function). So I went into hospital looking like a shoo-in for the hunchback of Notre dame and came out the next day six inches taller and not needing crutches, having had the stenosis resolved. Tramadol helped with all sorts of other pains but not severe nerve pain from pressure on the spine, it can make you more relaxed and able to sleep sometimes. Its said to be addictive, though side effects can discourage any repeat pill popping - at least with me.

          The biggest success with back pain has been through posture correction while sitting and standing and trying to keep mobile, unfortunately, this cannot repair nerve damage or other joint wear and damage. So ineffective pills continue to be taken while I hope for something better.

          I'm not sure which is worse, growing old or the alternative.

          1. Anonymous Coward
            Anonymous Coward

            Re: Nothing works faster ...

            Exactly. Treating the cause of the pain is obviously the best thing but when that can't be done or when you have to wait nerve pain isn't touched by paracetamol. Worn out discs which cause nerve pinching or broken vertebrae hurt... a lot.

            My doctor kept refusing to prescribe anything stronger saying that there was nowhere to go from there or that I'd be addicted or that I was an addict. That left me in agony for years. Eventually I saw a pain specialist who put me on a Morphine patch. Finally the pain became manageable and I could start to do things again.

            In the end I moved countries and had an operation which has much reduced the pain and I have days where I don't need medication at all. So much better than in the UK where I was sent for scans but has to wait months and in one case more than a year. Where I was sent to see a specialist only to actually see the registrar who hummed and hurred and never did anything, interspersed with waits of 3 to 6 months. The NHS could save a lot of money by actually treating people rather than making them wait and paying for the medicine the GP visits and the useless registrar visits all the time paying various benefits and giving out blue badges.

            Where I am now, I saw the specialist directly and was operated on a month later, recovered for three months and could work again. Surely that's got be cheaper overall.

            1. I ain't Spartacus Gold badge

              Re: Nothing works faster ...

              I never even had paracetamol mentioned to me. Though my problem was neck/upper back pain. I was told to use ibuprofen, which doesn't work. Well to be fair, it seems to take a few days to work on joint problems, so with something sporadic it's hard to know when the pills have fixed it, or just the waiting.

              My friend with spina bifida was prescribed 1500mg ibuprofen. At which dose he saw pink elephants.

              I was on a muscle relaxant called robaxin, which seems to have disappeared now. And that worked. Didn't reduce the pain, but seemed to stop the spasms. It was rather annoying that the buggers were about an inch long, and you had to tip your head back a long way to swallow them. Which with a bad neck...

              I can bear the pain if I know it'll stop. So I've only asked for painkillers once. Which was when my whole neck and upper back went into spasm, and I betook myself to casualty. I couldn't even lie down. It's the most amazingly painful thing that's ever happened to me. Or I ever hope to. It went from intense pain that could just be ignored to absolute agony if I moved my head. For which I got morphine and muscle relaxants. They worked, but can't remember what they were called. Because of the morphine. I lost a week. I remember deciding I could work, after 4 days, and I remember leaving at lunchtime, because it hurt too much. I then had the embarrassment of phoning several people the next week to apologise for not getting back to them for a week, only to be told, "you spoke to me on Thursday."

              "I did? Oh. What did I say?" It appears I said the right things, I just didn't take any notes, or remember anything about it.

              Exercise keeps me OK so far. Morphine sucks, and is to be avoided at all costs. Seeing as it took a week to die down, that muscle relaxant probably wasn't much cop either.

              1. KayKay
                Happy

                Re: Nothing works faster ...

                Anything with spasms -- magnesium. Available in tablet form in various chemical forms, but by far the best is Epsom Salts :(magnesium sulphate) which you "take" by soaking it up through your skin, in a lovely relaxing bath with a cupful of it tossed in. If you are unfortunate enough to only have a shower, soaking the feet in a bucket, or even wearing Epsom salts soaked long socks (until they dry out) will do the trick (every second day is enough). Magnesium is not only a superb muscle relaxant, but an important mineral in building bone, useful for anyone with fracture or crumbling problems in the spine.

                Paracetamol is good for toothache and headaches, if taken together with aspirin (they seem to double each other's effectiveness). Aspirin alone will prevent blistering of burns, if taken immediately.

      2. EddieD

        Re: Nothing works faster ...

        You have my total sympathy, and I agree totally. When my back goes, no pill works.

        If I spend a lot of money and go visit a guy who beats me up for an hour or so*, I get some relief, but that may be just because he isn't hurting me any more.

        Doctors should really stop just handing out pills to get rid of folk and take a proactive role - instead of masking the pain, try and find out what's causing it, and remove that - treat the cause, not the symptoms.

        I'll stop now before I start ranting about antibiotics.

        *Remember the scene in Dirty Harry....

        1. AbelSoul

          Re: beats me up for an hour or so*

          "*Remember the scene in Dirty Harry...."

          Jacob's Ladder has some painful looking chiropractor action too.

      3. MrXavia

        Re: Nothing works faster ...

        I hope you find a way to fix your back problems, not just mitigate them...

        but I find Tramadol works for most stuff... although many people have addiction problems when it comes to that drug, it binds to the opioid receptor.. Personally I have no problem with them, they are a handy stop gap when I get severe back pain or migraines... (but then again Paracetamol/Ibruprofen don't actually seem to work well for me and cocodamol just gives me headaches, so I have little choice in what I take when I need to..)

  3. SuccessCase

    My advice. Buy a good chair.

    I had a knee problem a couple of years back. Due to an op that went wrong it swelled up like a balloon and became crazy painful. Being self employed I continued working but with my knee propped up. This put my back out. Badly. The two things, the knee and the back played off each other. Eventually the knee problem healed. But the painful back remained.

    I used to be sceptical about the many reports you hear of x, y or z, being unable to work because of a bad back. While I remain sceptical of many cases, I now understand just how bloody painful it can be and how absolutely a bad back can destroy your ability to work, even when your work is confined to being done at a desk. I learned first hand, for example, that even spending prolonged periods lying down, whilst giving respite, can lead to deterioration of the problem.

    I was beginning to despair as I could no longer afford the lost days work. Someone suggested I get a better quality office chair. My existing office chair already gave me back support and I was sceptical changing it would make much of a difference. I figured the cause of the problem had been my knee and my existing chair had adjustable lumbar support and since I was beginning to feel the pinch didn't feel I should be spending the money.

    Anyway, I was ready to try anything. I went to John-Lewis and spent literally an hour moving from office chair to office chair to check which one felt best, decided there was no point in half measures and placed no limit on my budget. I ended up opting for a Herman Miller Sayl chair. It felt better for me than even the more expensive Herman Miller Aeron, the gold standard of healthy office chair design. I wasn't going to muck about, and was perfectly prepared to purchase the Aeron if need be. But the Sayle just felt marginally better for me and the engineering principles behind the subtle design of the "suspension cable" back appealed to my engineering mind (as you sit back in the Sayl, your own body weight causes the "cables" to subtly lift the small of the back).

    I was stunned by how quickly my back improved. In fact it went from feeling extremely painful to better than it had felt since my teenage years (I'm now in my forties), in a period of just three days.

    Now I've become a good office chair evangelist. It's difficult to convey just how transformative and revelatory the effect of a properly adjusted, well fitted chair can be. If you have back problems, don't hesitate, don't buy just anything, but test out the best chair for you. Make sure it can be adjusted and has a tilt back mechanism where the power required to tilt it can be adjusted and fine tuned (whilst looking to my eyes "slobby", being able to tilt back is good for your back). Lastly, don't let price be a factor. The best adjustable chair for you may be cheap and/or may be expensive, but you need to be able to try them out before buying.

    1. A Non e-mouse Silver badge

      It always amazes me how people put up with crap office chairs (and hence employers get away with supplying crap office chairs!)

      Standard office chairs are terrible and just encourage bad posture. I always fight to have a good office chair. As geeks, we may want to have the latest computer/monitor/software, but the first thing we should fight for is decent office furniture: Desk and chair. They'll make you a more efficient employee way more than the latest tech.

      1. Anonymous Coward
        Anonymous Coward

        Agreed

        I've been at the stage where I would straight up kill a man for a slightly higher desk.

        1. Gene Cash Silver badge

          Re: Agreed

          Many years ago, I put some casters on the end of 1x1s, then bolted the 1x1s to the desk so it raised it a full 8-1/2" - It's a Radio Shack computer desk, which tells you just how old it is, but it's basically a box with 2 sides missing, 3 boards supporting the top board.

          Now I work 12 hours a day at the keyboard without ever having wrist/arm pain, while 4 of my friends have serious carpal-tunnel issues, one so bad he had to quit coding.

          When I worked in the office, I insisted on having a lift for the keyboard. Fortunately they had these hydraulic things which I simply jammed in the full-up position.

      2. Triggerfish

        You guys have my sympathies, I have only had back pain from pulling muscles etc but I would say,

        while you fight for a good chair, can I also add fight for a good mattress. I've worked for people who have owned bedding factories and got a chance to try out different mattresses. After years of being a student and sleeping on any old bed and then a cheap bed after graduating it was bit of a revelation sleeping on a new mattress that suited me, all the little aches and pains that you stopped noticing just disappeared.

        It makes sense you spend a fair bit of time each day in bed and its when your body truly wants to let all the muscles relax.

    2. KayKay

      Chairs

      Totally agree. Had my office chair dropped and broken in a move, and worked from home for 8 days sitting on a dining chair (move coincided with a deadline). Nearly killed me. Price was a big factor at the time, but I found a specialist shop with a good range of affordable refurbished chairs.

  4. Neil Woolford

    Paracetamol - the truth?

    Or is it just me. I've never found it the least use as a pain-killer or anti-inflammatory.

    Aspirin seems pretty good if your gut tolerates it, Ibuprofen certainly acts well as an anti-inflamatory for me (as do Diclofenac and Naproxen) but for pain relief the opiates are the way to go. In the UK Codis (Codeine and dispersible Aspirin) is pharmacy only but doesn't need a prescription. However it has moved 'behind the counter' and risen in price a lot recently.

    But yes, if you are getting chronic back pain, then posture, working arrangements and the right excercise are probably as important as anything.

  5. davcefai

    Incorrect

    Panadol + Codeine + Caffeine preparations work a treat on me. I know that codeine is addictive but as my consulting surgeon put it, it doesn't matter 'cos I'll always need to keep taking it.

    All of which makes me wonder how well the test was conducted.

    1. A Non e-mouse Silver badge

      Re: Incorrect

      The study was testing the effectiveness of Paracetamol for back pain, NOT painkillers in general.

    2. Nigel 11

      Re: Codeine, opiates in general

      I thought the addiction danger was that these drugs become less effective with repeated use. At which stage you may be tempted to take a larger dose. Which then becomes ineffective with repeated use, and you stumble down the path to total addiction to doses that would kill a non-addict, and ultimately to doses dangerous even to an addict.

      On the other hand I'm also aware of quite a bit of literature suggesting that if you do not have an "addictive personality", you won't have any trouble keeping your intake of opiates at the effective therapeutic dose and no higher. There's a lot not yet understood about opiates, even after centuries of use and abuse thereof.

      Oh, and there were many Victorian addicts who lived quite long and productive lives. Perhaps medics shouldn't care about people becoming addicted, if they have nothing else that can deal with a chronic source of severe pain. It's not as if opiates are expensive.

  6. John Smith 19 Gold badge
    Unhappy

    Never thought paracetamol was *any* good for it

    I always associated it with Lemsip as "Something for a tickly cough."

    IE B**ger all use for back pain.

    A Codeine Paracetamol mix is meant to be pretty good if you don't mind potential constipation (even at low doses).

    That said I found a little gentle stretching and staying mobile cleared up my back pain within a few days.

    But I fully admit I was damm lucky.

  7. Anonymous Coward
    Happy

    The human spine is poorly-designed for the rigours of modern life,

    You mean sat on your ass for 8 hours day, only moving to eat some processed food and interspersed with the occasional movement to the bus or car?

    As with the obesity problem, many of our modern aliments are not caused by bad diet, pollutions or the stresses of modern life, but the fact the majority of us these days are sat around on our arses day in day out. Many peoples can be fixed or issues lessened by getting out and about a little more. For may with back issues, doing a batch of sit ups each day will help (yes stomach muscles help with you back, not back muscles).

    The only concern I have about the report is the fact that it was conducted by one of the largest pharma's in the world testing one of the cheapest drugs in the world. It may be genuine, but when you have a company with a vested interest in getting a negative result, you have to wonder.

  8. Lee D Silver badge

    The reason that paracetamol is prescribed is because it tends not to conflict with other things you're taking.

    My ex- has joint hypermobility syndrome - basically every joint is completely loose, your knees can go backwards, your hips dislocate, etc. This puts enormous wear on the joints and gives you arthritic symptoms (enough that it's often misdiagnosed as arthritis - basically the OPPOSITE of reality - itself).

    The doctor put her onto all sorts to ease chronic joint pain and at one point told her off. He'd prescribed her something, so she'd stopped taking paracetamol. He told her the point of paracetamol is that it's low-impact on other drugs, and can be taken (on doctor's orders!) en-masse without prescription, so she could still take some ridiculous number of paracetamol AS WELL AS her other drugs. She was taking so many paracetamol, on his specific advice, that it was actually difficult to buy them without people asking questions or running into per-store limits.

    The point of paracetamol is not to cure long-term, high-intensity pain. It's to take the background ache down a peg or two and not interfere with better painkillers. That's why you should use it for a headache, say, but not take JUST paracetamol when your break you back.

    1. John Latham

      @Lee D

      "The reason that paracetamol is prescribed is because it tends not to conflict with other things you're taking."

      That's one reason. Another is that's it's fairly benign on the GI system compared to the alternatives.

      1. Alister Silver badge
        Boffin

        Re: @Lee D

        "The reason that paracetamol is prescribed is because it tends not to conflict with other things you're taking."

        That's one reason. Another is that's it's fairly benign on the GI system compared to the alternatives.

        It is not, however, benign on Liver function, hence the low levels needed to become toxic. An acute dose of 10 grams (that is, taken all at once) will severely impair liver function, and if untreated will kill you. This is why it's the drug of choice for suicides, although most "cry-for-help" takers of paracetamol have no idea it will kill them so soon.

        Paracetamol is primarily an antipyretic - that is, it reduces the body's temperature, and therefore works well on the symptoms of bacterial and viral infections. It's efficacy as an analgesic has always been a secondary consideration.

  9. Adam 61

    Back pain woes

    I too suffered quite a lot from back pain on account of having slipped 3 discs in my lower back from a collapsed scrum playing rugby (IT Stress relief), but also related to an earlier knee injury.

    I can categorically state that paracetemol was of no use, and in fact after a while of being on the codeine it's effects became lessened to the extent that it didn't touch the pain any more and I was prescribed tramadol - who's effects I can only liken to feeling like I was walking around on a cruise ship all the time on a gently lolling ocean.

    Naproxen was a much more effective anti-inflammatory than Diclofenac which can upset your stomach a bit (still counteracts the codine for a nice balance).

    Anyway in the end I'd had a few cortisone injections which lasted a couple of weeks each but the eventual decision was to have surgery followed up by a series of physio with a heavy leaning to Pilates. I stopped taking the meds after the operation.

    Other changes I made were - 1) swap the car i had with sports seats to a boring yet comfy car with very good heated seats, 2) got a decent office chair,3) Slept on a hard/orthapedic mattress - soft ones don't help 4) When working made sure I got up every 40 - 50 mins or so and walked (walking really helped things get back in place) around, and continuing with the pilates and back stretched every day (only 5 mins or so).

    Now I am fully functioning with only a mild niggle occassionally - if ever I feel dodgy i do a good set of pilates exercises which help your core which holds everything in place where it should (in my case where it was a lower back issue anyway). I've also started playing sports again which again if you prepare properly (pilates and stretching) you can take part in again - yeah I got a bit of stick at first, but I really didn't care as I was happy to be active again after 2 years of inactivity. These days the only thing that makes it stiffen up is a long car journey (i.e. 3 or more hours)

  10. auburnman

    I have to wonder

    Exactly how controlled the control groups in this experiment were; after all paracetamol is one of the most readily available pain medications in the developed world. Did the placebo group think they were taking paracetamol when they were popping the sugar pills? Were any measures taken to control for them picking up paracetamol at the corner shop?

    P.S. For the commentards living with back pain, as I haven't heard them mentioned yet I will chip in that adjustable desks which allow you to stand for a portion of your day are becoming more and more common.

    1. Anonymous Coward
      Anonymous Coward

      Re: I have to wonder

      Variable height desks, enabling one to stand to work, ought to be compulsory in every office. I never saw them in GB. But where I am now they are very common. Those at my current place are all "Stehpult" ("standing desks").

      They are excellent for providing a break from sitting (or vice versa if you prefer) and are said to be the equivalent of some significant level of daily exercise. A good side-effect is that it is much easier to look with a colleague at a screen than when both are sitting and contorting the whole body to get a view.

      Of course, regular and frequent exercise is immensely valuable - a good bout of proper running, off road, a few times, fixed my last agony session.

  11. Tanuki
    Thumb Up

    Double-strength Placebo™

    Essentially, Paracetamol _is_ being used as a placebo in this case. Same goes for that other dish-it-out-to-get-the-patient-out-of-the-surgery-when-you-dont-know-whats-wrong-with-them offering, Ibuprofen.

    Given the state of the pharmaceutical industry I wonder how long it will be before someone brings out "Placebo Extra™" - the proven power of Placebo™ you know and trust, now in a new double-strength formula. Available in easy-to-swallow caplets, suppositories*, or soluble formula.

    *For all the good they'll do you you might as well shove them up your...

    Placebo™ - so effective all other drugs are tested against it!

  12. Jim 59

    Another history in case it helps anyone

    Interesting stuff here, especially about the chair. I might be doing the Herman Miller thing after reading the above.

    I have chronic back pain which 18 months ago suddenly became nerve/sciatic pain, after I spent Christmas sitting on somebody's knackered sofa. made basic life functions difficult.

    1. Doctor visit. Prescribed powerful drug for 28 days. Doc said it might fix my back by enabling me to walk and move normally for a month. It did. Removed all pain and the nerve pain did not return after the drug stopped. It was Naproxen. Pain free for 8 months. Interesting that the drug did not fix my back, just removed the pain, which enabled normal movement, which fixed the back.

    2. "Normal" back pain returned (not nerve/sciatic pain). Obtained prescription again. Worked again but not quite as well. Little pain for 2 months.

    3. "Normal" back pain returned. Obtained same prescription. This time it did not relieve the pain much or help. Visited local chiropractor on recommendation. Two visits later all pain was gone.

    4. Two months later, dreaded nerve/sciatic pain came on. This can be hard to shift. Eventually visited a highly regarded sports Physiotherapist. What he did was similar to the chiropractor but more rigorous, and more vigorous and extensive. He appeared to know exactly what the vertebrae were doing and where they were misplaced. Also he gave me stretches to do every day and good advice. After 2 visits to him the pain was gone. That was about a month ago. I was going to arrange a 3rd visit but no need so far.

    So now I am 90% pain free, doing the stretches every day and continuing to to my Alexander technique/semi supine position for 20 minutes each day. This works wonders with "normal" back pain but does not touch nerve pain, I need the Physio for that. If you have medium "normal" back pain I can recommend it for pain relief.

    Stuff I tried that did not work

    - rented another car for 2 weeks. A big car with soft suspension, rather than my low sports car with its very hard springs. Made no difference.

    3. Weeks later nerve pain came on. Prescribed Chropractor visit did not help.

    1. phil dude
      Boffin

      Re: Another history in case it helps anyone

      @Jim 59 - I really hope you find some relief for your pain.

      However...

      "3. Weeks later nerve pain came on. Prescribed Chropractor visit did not help."

      that is not so surprising...

      As Ben Goldacre's excellent book points out, double-blind randomized trials are almost the only difference between medical science, and "bloke down pub said". (yes, I'm paraphrasing...)

      For UK readers this is the case that brought it to prominence http://en.wikipedia.org/wiki/BCA_v._Singh

      The Nature article is here via PUBMED explaining why it was important

      There is an aggressive market in the USA (it is has serious cash behind it, apparently trying to get into the UK too) for trying to sell treatments that cannot be disproved, or are based upon ludicrous premises.

      If you get a massage and it makes you feel good, that's great. But some of the complete and utter BS I have heard "D.Cs" spout is frankly scary for people supposed to be medical professionals.

      On a pharmaceutical note, in the same way as we have no new antibiotics, the same is pretty much true about pain medication that is not opiate based (to distinguish from NSAIDs).

      If you have inflammation the COX-2 inhibitors (e.g vioxx, celebrex) can be very effective (if they don't have other side effects for you...)...

      P.

  13. Truth4u

    not news

    ibuprofen works

    codeine works (so of course they'll make it hard to get any)

    paracetamol is less effective than chewing gum (hence why its easy to buy... they would never let the public buy analgesics that actually work - too scared some idiot will decide to top themselves with the whole pack)

  14. Paul Webb

    AllTrials campaign

    On a semi-related note, I see that GSK is a supporter of the AllTrials campaign (http://www.alltrials.net/) which calls for all clinical trials (past and present) to be registered and their results reported. Whether they are just playing lip service or not, we'll just have to see.

  15. Anonymous Coward
    Anonymous Coward

    Personal tale ... (cannabis)

    my wife has MS, and uses a wheelchair. Two of her permanent symptoms are muscle spasms, and backache, from using a wheelchair - even though it's a custom-made jobbie to match her height and leg reach perfectly. The backache is not a postural issue, but caused by muscles in the back refusing to do their job properly, thanks to the spasms, which also create a twitchy leg, with pain.

    In 20 years, we've tried every combination of muscle relaxant, and painkiller, to very little avail. Except to become addicted to Clonazepam (thanks docs) which is now a lifetime habit (quitting benzodiazepines is not something any doctor recommends).

    Because I am a free man, not a number, I decided to **** the man, and do my own research and development. An obvious starting point was the fact that quite a few of my wifes friends from support groups have gained relief from smoking cannabis. Because I'm not a fan of dodgy characters with unknown wares in pub car parks, I started to grow our own. After a few years, we've found that strains with an equal THC/CBD ratio do best at easing pain, and calming spasms. It's not smoked in herbal form. Butane is used to extract an oil, which can be used in cooking, or a drop placed on a cigarette (current research is looking at the practicality of using an e-cigarette).

    The interesting thing, is when a single drop is used (actually it's 3), then the anti-spasm properties and analgesic properties kick in, but not the psychoactive properties. In short, there's no high.

    I make no apologies for breaking a stupid law, which seeks to constrain peoples personal liberty. By all prohibit trade in cannabis. By all means make it illegal to sell. But when someone is doing something in their own home, that is no harm to another, the law can fuck right off. Especially when you can happily brew as much beer as it takes to drink yourself to death in the same house, perfectly legally.

    1. phil dude
      Boffin

      Re: Personal tale ... (cannabis)

      Indeed, the sooner we can get all available compounds that might reasonably have a clinical effect into the analytical framework that is the scientific double-blind randomized trials, the better.

      The problem is that big pharma and the government have a perverse incentive to not allow this.

      Natural compounds cannot be patented therefore all pharmaceutical compounds are by definition either derivatives of natural compounds or those found in random screens (chemophoric compounds -think of them as variations on a theme) , that still have a measurable effect. Often many unwanted ones, since the natural compounds have had a billion years evolution that fit specific locations, biochemical synthesis is often very specific, making only what's needed, when its needed (e.g insulin in response to blood sugar).

      Pharmaceutical design and manufacture is a non-trivial technical activity. But it exists at the precipice of commercial viability. If it cannot be sold, it doesn't get made. Or worse it doesn't make enough money, in which case noone else can make it until the patent expires.

      In those states that have full legalized cannabis (Colorado and Washington) there is good opportunity to start collecting clinical data on a wide range of clinical effects.

      Here's a recent one from Europe to be getting along with , "Targeting CB2-GPR55 (Cannabanoid) Receptor Heteromers Modulates Cancer Cell Signaling" with THC...

      P.

      1. KayKay
        Unhappy

        Re: Personal tale ... (cannabis)

        Big Pharma is working on synthetic cannabis, not containing THC. The legalised medical marijuana places have worked out, by trial and error, what % works well, and actually offer different strains of the plant for different medical problems. But I'm betting that if it becomes fully legal, it will be the synthetic pill-form prescription-only profitable type, NOT letting everyone grow their own. Fools. This is being debated in Australia right now, and they keep talking of this "medical marijuana", NOT about "marijuana for medical purposes".

  16. Anonymous Coward
    Anonymous Coward

    Show some spine

    I did, about three inches of it as the surgeon cut bits of cartilage out. That was about eight years ago and not had anything more than the odd ache since. Before that nothing worked to ease the pain.

  17. Anonymous Coward
    Anonymous Coward

    Needs more information added....

    Paracetamol is nigh on useless on it's own! It works best in conjunction with other medications, especially opioids (not opiates as people wrongly call them) such as codeine, di-hydrocodeine, tramadol, morphine, oxycodone, etc. It also enhances the effects of NSAID's such as ibuprofen, diclofenac and naproxen. It is recommended by almost every pain clinic physician because of the enhancing analgesic effect it has in combination with other medications - hence why it is used in combinations such as Co-Codamol (parcetamol + codeine), Co-Dydramol (paracetamol + di-hydrocodeine), Co-Proxamol (paracetamol + dextropropoxyphene - which has now been withdrawn due to causing other potentially lethal problems), Percocet (paracetamol + oxycodone), etc, etc.

    Living with several different spinal conditions for the last 20+ years (Cervical spondolysis, prolapsed/herniated lumbar disc's and Multiple Sclerosis) means I have been around the block several times with regards to medications for pain relief, and without fail 100% of pain and spinal specialists have prescribed paracetamol alongside the main pain relief.

    1. Vic

      Re: Needs more information added....

      Co-Proxamol (paracetamol + dextropropoxyphene - which has now been withdrawn due to causing other potentially lethal problems)

      I had an operation on my hand some years ago, and after being discharged from hospital, I was prescribed co-proxamol.

      It was utter shite. Did nothing for the pain.

      I gave it up & self-prescribed G&T, which did a marvelous job of pain relief. Don't remember much of that week, though...

      Vic.

      p.s. for the back-pain sufferers here: the single most effective thing I've found is hanging from something high (my landing) by your hands. It's astonishing how much effect it can have. But landing on your feet when your arms give up can be a pain...

  18. tentimes

    Pain is caused by faulty muscle memory

    I speak as someone who was on Fentanyl patches, along with many other pain killing drugs. I read a book called "The hidden psycholgy of pain" by James Alexander, and I researched article on pain really being caused by faulty muscle memory.

    After 6 months of working through it I ended taking any painkillers and rely now on exercise and occasional physio to get my muscles out of their chronic pain state,

    I am in a hell of a lot less pain than I was whilst on painkillers, some days even pain free, and I am convinced that the only way to fix the problem is by accepting, even if told different by doctors, that *chronic* (not acute!) pain is caused by a combination of psychology, painkiller feedback and faulty muscle memory.

    Exercise, however hard at first, is the only answer. It took me 6 months to work up my exercise regime to that of a semi-normal person, but I am now in a much, much better place both physically and mentally. At one point I wanted to die the pain was so bad and I had lost all hope.

    I would implore anyone who's life is blighted by pain to think the unthinkable and try something different like I did. At one point that view would have made me extremely angry thought.

    To anyone in bad chronic pain, you have my sympathy - I know what it is like.

    1. phil dude
      Pint

      Re: Pain is caused by faulty muscle memory

      take the "woo" out of yoga and you get muscle memory tuition. Tai chi, ballet and martial arts too. I was taught some "carpal tunnel" exercises that really helped. Sometimes I just think we need to make keyboards obsolete, and just have thought controlled keyboards!!!!

      Remember, everything in biology is slowly adaptive (usually), so long as there is a functioning feedback system. You can increase most things by exercise, it just requires consistent form. Think "boiling frog" when "changing diet" or "running a marathon" and you get the idea...

      There is some clinical research that some pain is in the mind - though Stephen Fry putting his hand in hot/cold water and swearing might not suit some people - Brian Blessed was a quality event ;-)

      P.

  19. John H Woods Silver badge

    May not work for you but ...

    ... I suffered with some back pain - clearly not anything like as bad as some of the unfortunate commentards above - and found only one thing that helped me (which may, of course, be a placebo):

    an inversion table. Got it in ASDA for 50 smackers. Looks like a bit of bondage equipment (in fact my wife humiliated me and amused the entire aisle by loudly announcing "Honey, we aren't going to be using that for what you think we're going to be using it for").

    Adjust to fit your height, step on (you might need an attractive assistant to start with), fasten your ankles in and rotate. You can start off just very slightly past horizontal and build up to hanging fully from your ankles if you want to go all the way (only a minute or so). I used to get off feeling an inch taller and suddenly pain free, as if it had just been switched off. And I say used to, because now I don't use it at all, as I no longer feel the need.

  20. Michael Hoffmann

    I'll add mine...

    6'4" with mild scoleosis, back problems had been with me since my teens. Twice I'd had lumbago so bad that the inflamed nerve-muscle spasm feedback loop affected my breathing. They injected opiates, AFAIR, directly into the mess to shut everything down.

    Only thing that finally broke it was physio-therapy, regular massages (deep tissue, not feel-good "Swedish"), getting my butt to the gym and - of all things - horseback riding. Now in my sixth decade, I still get the odd back-pain episode, because as a consultant on client site you always get the crappy chairs, but nothing like it used to be. Back muscles are strong enough that keep the bent spine in check. A spot of canter and a bit of massage keeps everything loose.

    Like others wrote, Paracetamol does nothing for me, painwise. All it does is what the song "Pretty Paracetamol" describes, if any others remember Fischer-Z. And I don't mean the "soothe my aching brow"... I mean the "multiply by two in the mirror on the wall" part.

  21. Boris the Cockroach Silver badge
    Unhappy

    Tramadol or

    Morphine are the only pain killers I've found that actually work

    The only downsides are the addictive side effects......

    1. I ain't Spartacus Gold badge

      Re: Tramadol or

      And the short term memory loss.

      The constipation's not ideal either.

      Did I mention memory loss?

    2. WraithCadmus
      Pint

      Re: Tramadol or

      I do find opioids can be very moreish.

      Icon: Checking for drug interactions

  22. Lordy Lordy

    Treat the cause not the symptoms

    Back pain is typically caused by subluxation - a dysfunctional spinal segment which is fixated. No pills will cure this. Losing weight, exercise, diet can dramatically improve the symptoms and be an inportand part of rehabilitation but most people want a pill because they are ill informed and ill advised by those who they trust. Education for the quacks and for the patients will serve the general population best.

  23. Alistair Silver badge
    Holmes

    Never ran into paracetamol.

    But good lord I have to thank whomever concocted Naproxen. And thank the sweet lord that the patent has expired (at least in Canada).

    Ex skater, I've done my knees in four times over the years, and I periodically pay for it, most notably after a spill during an afternoon with a paintball gun. In that case, pulled hamstring and two pinched nerves in my left hip left me basically flat on my butt -- Naproxen just plain works on things like my knees, and the hamstring issue.

    I was fortunate and ran into a chiropratic intern that found the nerve pinches quite quickly. And as warped as it might sound, three massage sessions later the nerves stopped harrassing me. It was however about 5 weeks of stretching and exercising to get past the hamstring problem. That would not have happened without Naproxen.

    I've found Ibuprofen keeps the pain to a dull roar with the knees when they decide to file a complaint, and the Naproxen makes it possible for me to do the stretches and bends that get them to toe the line again.

    As for back pain, yes yes yes yes to the office chair. You have a bad chair, you might as well lie on the floor and have your kids use your back as a judo practice target. Nothing better than getting a chair configured to fit correctly.

    1. Swarthy
      Childcatcher

      Re: Never ran into paracetamol.

      "You have a bad chair, you might as well lie on the floor and have your kids use your back as a judo practice target. Nothing better than getting a chair configured to fit correctly."

      Odd, when my back acts up, that is how I get relief, having the (small) children jump on it and use it as a judo(-ish) practice target.

  24. Uffish

    Exercise to strengthen back muscles to allow corect posture

    An MRI scan showed that my lower back vertebrae were like a badly stacked pile of assorted crockery.I had regular bouts of back pain, simple pain killers (aspirin, paracetamol) were no good. Went to doctor who also suffered from bad back (tall) and was prescribed his own three pill cocktail (anti-inflamation, muscle relaxant, pain killer - can't remember the names) which was wonderfull, iboprufen was the emergency substitute (about half as good).

    The bouts of back pain slowly got worse and included trapped nerve pain. I tried physiotherapy as a palliative and it worked. Basically, excercise built up the abdominal and back muscles,and I (re-)learned a better walking posture (straighter back). It has worked well.

    1. JimWin

      Re: Exercise to strengthen back muscles to allow corect posture

      I had a bad and bent back (scoliosis) some years ago and eventually had a discectomy to remove a disc bulge that was pressing on a nerve in the spinal column. It was caused by sitting down all day in the office chair (weakening the back) then running and cycling for recreation (and stressing the weakened back). The medics said the solution was to do daily stretches for flexibility and exercises to build up muscle strength in the back. With help from a sports injuries book, I started a 20 minute daily routine of exercises and muscle stretches (all standing and floor work - only needing a free wall and a floor mat). They worked wonders. As a result, I no longer have any back trouble (fingers x'ed). Folks on this forum are probably, like myself, sitting over a keyboard for much of the day. The human body wasn't designed for this. So we need to mitigate issues such as back pain through strength and flexibility. Not proselytizing BTW, just what worked for me.

    2. JimWin
      Happy

      Re: Exercise to strengthen back muscles to allow corect posture

      I had a bad and bent back (scoliosis) some years ago and eventually had a discectomy to remove a disc bulge that was pressing on a nerve in the spinal column. It was caused by sitting down all day in the office chair (weakening the back) then running and cycling for recreation (and stressing the weakened back). The medics said the solution was to do daily stretches for flexibility and exercises to build up muscle strength in the back. With help from a sports injuries book, I started a 20 minute daily routine of exercises and muscle stretches (all standing and floor work - only needing a free wall and a floor mat). They worked wonders. As a result, I no longer have any back trouble (fingers x'ed). Folks on this forum are probably, like myself, sitting over a keyboard for much of the day. The human body wasn't designed for this. So we need to mitigate issues such as back pain through strength and flexibility. Not proselytizing BTW, just what worked for me.

  25. Jan 0

    Why choose pain killers rather than treatment?

    A York University randomised trial (2007 - 2010) showed that specific Yoga exercises were the most effective treatment for lower back pain. This led to a programme called "Yoga for for healthy lower backs" with 12 week courses available in many parts of the UK. See http://www.yogaforbacks.co.uk/

    ObDisclaimer: I was used as a 'practice class' by someone who's done the training. I don't suffer from chronic back pain, so can't comment on the efficacy, but the exercises were simple and pleasant.

  26. Sorry that handle is already taken. Silver badge

    Paracetamol works a treat

    When it's got 10mg of Codeine in it too

  27. Anonymous Coward
    Anonymous Coward

    Re. weed

    Cannabis should be legal for back problems, and chronic pain in general.

    Anyone who disagrees has obviously never suffered with chronic back pain.

    What annoys me more is the idiots who insist that cannabinoids have no medical applications, when nearly all of the papers published suggest that it is at least as effective at relieving pain as opiates, if not more so.

  28. WageSlave

    It's all about fit muscle

    A back is held in place by fit postural muscles.

    If they are unfit the back goes out of alignment, joints get inflamed, nerves get trapped, and discs slip.

    If you just do one thing (eg relax the muscle), it's going to be even worse at holding everthing in its right place.

    If you do the brutal massage but don't exercise it will of course all go back to where it was before.

    If you rely on anti-inflammatories, you're fixing nothing, only masking symptoms.

    If you mobilise the joints with physio / alternative, you relieve an immediate pressure point, but don't fix the posture/muscle that's pulled it or relaxed it into the wrong position in the first place.

    (oh, and I've personally found Chiropractic to be a money-extraction machine with no good result).

    Ibuprofen provides short-term relief, (and the long-life formulation gives me a full night's sleep), so can be useful.

    Physio is highly variable depending on the practitioner, usually useless, but can be good at pinpointing the bit that's failing, and it will be different for different people

    But the best ever has always been brutal sports massage combined with long walks, plenty of gentle exercise, and a decent pillow.

    If there could only be a decent Wii-type gesture control for an editor, making us wave our arms and jump about to cut code in super-quick time, we'd all be fit as butcher's dogs :-)

  29. Roger Mew

    Dihydracodeine

    Hi I am The above known as Dicodin. Now the use of that is supposedly enhanced using paracetomol. Certainly paracetomol on its own is useless, however the action of the dicodin is certainly enhanced.

    Without my daddy's little helper I really could not cope. I have a prolapse between T8 and T9 that has gone in and touches the spinal cord causing pains around my midrift and everywhere else on my right side. It has also caused a walking problem.

    The real relief, riding my old custom cruiser motorcycle or a sit up and beg car with loads of head room.

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