Taking the pain away

In many cases, the modern, mainly sedentary lifestyle is the cause for the pain in the back. Many people spend much of the day in a sitting position, be it in the car, at a desk or relaxing on the couch in the evening. Constant physical and mental strain, non-ergonomic seating, obesity, lack of muscle strength or even draughts can also trigger backache. For many people with chronic complaints, several causes act together. To make the pain more bearable, many sufferers adopt relieving postures that are unnatural and affect other structures. In the end, this only intensifies the complaints.

Most backache is uncomplicated and can be managed through exercise, medical education and appropriate drug therapy. Self-medication focuses on the short-term use of painkillers. They make it possible to remain as active as possible in everyday life and to continue pursuing a professional activity. However, painkillers have a purely symptomatic effect. They only relieve the pain, but do not fight the cause of the backache. The drugs of choice in the acute stage are non-steroidal anti-inflammatory drugs (NSAIDs) in oral form, such as ibuprofen and diclofenac.

The potential of orally administered NSAIDs to relieve pain and improve function in the short term has been demonstrated in several reviews. The individual NSAIDs do not differ significantly in effectiveness. However, the chosen NSAID should be dosed as low as possible. According to the guideline, this means a maximum daily dose of up to 1.2 g ibuprofen, 100 mg diclofenac or 750 mg naproxen. If patients do not experience sufficient improvement, they can increase the dose briefly to up to 2.4 g ibuprofen, 150 mg diclofenac or 1.25 g naproxen. Side effects may include gastrointestinal discomfort (nausea, heartburn, stomach pain, gastrointestinal ulcers), headache, dizziness, decreased urine output, oedema and high blood pressure. If there is a particular risk of gastrointestinal complications, a proton pump inhibitor may be useful as a prophylactic measure.

Paracetamol, which is usually given for pain, is hardly effective for non-specific low backache. In current studies, neither pain nor functional capacity could be improved. In exceptional cases, however, the drug in a maximum daily dose of 3 g may be worth a try.

Pain ointments with NSAIDs are also popular in self-medication. However, there is a lack of sufficient evidence from studies for the use of topically applicable NSAIDs for non-specific low backache. Nevertheless, many patients find preparations with diclofenac or ibuprofen pleasant. The side effects to be expected are limited compared to oral application. What may occur are local hypersensitivity reactions such as itching, redness, rash or burning of the skin. An alternative to rub-in preparations are pain plasters.