General medicine

Back pain? Think twice about painkillers

Painkillers work poorly against low back pain. This is confirmed by researchers at Erasmus MC, who reviewed all the available evidence. They appeal to general practitioners: think twice before prescribing pain medication for lower back pain.

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The best remedy for lower back pain is being patient and staying active. Painkillers rarely work, and X-rays or CT or MRI scans are seldom helpful. Those are the conclusions of Dr. Alessandro Chiarotto and Prof. Dr. Bart Koes of the Department of General Practice at Erasmus MC.

In the scientific journal New England Journal of Medicine (NEJM), they summarize all available research on lower back pain without an apparent cause.


The scientists are particularly concerned about the use of painkillers. Even though guidelines for general practitioners advise against painkillers as first-choice treatment, many patients go home with a prescription. In fact, among elderly people with lower back pain, 72 percent were prescribed pain medication, a 2014 study by the Department of General Practice found. Some of that group were given an opioid, a heavy painkiller that is highly addictive and can lead to hospitalization.

But even with paracetamol, ibuprofen, naproxen, or diclofenac, one must be careful, Chiarotto believes. ‘All painkillers have side effects, and some can be addictive. Often, patients on painkillers are worse off instead of better off.


Chiarotto and Koes call on general practitioners to think twice before prescribing painkillers to patients with lower back pain. ‘Evidence for their effectiveness is simply lacking, particularly in chronic back pain,’ says Koes. ‘Instead, focus on education: tell patients that in most cases, the pain will resolve in a short period and encourage them to keep moving. Biking, walking, and swimming are all good activities that do no harm and can even reduce pain.’


Lower back pain is a common complaint in general practice. It is estimated that, on average, 40 percent of people experience lower back pain at least once in their lives. It is more common in people over the age of 40 and women. Usually, the pain disappears after a few weeks, but occasionally it becomes chronic. In most cases, no cause is found, and therefore the pain is labeled as ‘non-specific’.

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