Drugs not as effective for pain?

Some recent studies are questioning the effectiveness of drug use for pain, while another looked effectiveness of managing pain with herbal medicines.

• In a large, 5 year study of of patients with acute radiculopathy due to a herniated lumbar disk, “a short course of oral steroids, compared with placebo, resulted in modestly improved function and no improvement in pain.”  (JAMA 2015)
• A large, multi-site study of lumbar spinal stenosis concluded, “epidural injection of glucocorticoids plus lidocaine offered minimal or no short-term benefit as compared with epidural injection of lidocaine alone.” Lidocaine is like a dentist’s novocaine…it numbs the pain for a short while. The (unachieved) goal of the glucocorticoid is reducing inflammation and promoting healing.  (The New England Journal of Medicine 2014)
• In a meta-study of herbal medicines for non-specific low back pain that looked at over 2000 people from fourteen other studies, “Capsicum frutescens (cayenne) reduces pain more than placebo. Although Harpagophytum procumbens (devil’s claw), Salix alba (white willow bark), Symphytum officinale L. (comfrey), Solidago chilensis (Brazilian arnica), and lavender essential oil also seem to reduce pain more than placebo, evidence for these substances was of moderate quality at best. No significant adverse events were noted.” (Spine 2015)

When I read these studies, I see questioning of the marketing juggernaut that is the pharmaceutical industry. I also see huge efforts to be scientific and remove “the placebo effect,” effects that are often significant themselves, and can mask the clinical effect of a drug. This, in turn, makes me wonder why there isn’t more focus on harnessing the placebo effect as a tool to engineer empowerment with exercise through attentional focus and mindfulness.

A doctor at a recent seminar asked me if the some of the pain reducing effects of StrongPosture® protocols could be placebo. My response was certainly, but the difference is that in addition to relieving the distress of pain, you see (and the patient experiences) observable and functional improvement in motor control.

My Hanukah Gift Wish List: Studies looking at the mid- and long-term effects of engaging and empowering people with NMS pain to control their body and move well with BAM rehab protocols, and asking if it’s more effective than the pharmacologic bio-chemistry of commonly prescribed pain medications.

Cited Sources:

Goldberg, H., Firtch, W., Tyburski, M., Pressman, A., Ackerson, L., Hamilton, L., . . . Avins, A. L. (2015). Oral steroids for acute radiculopathy due to a herniated lumbar disk: A randomized clinical trial. JAMA, 313(19), 1915-1923. doi:10.1001/jama.2015.4468. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=2293294

Friedly, J. L., Comstock, B. A., Turner, J. A., Heagerty, P. J., Deyo, R. A., Sullivan, S. D., . . . Jarvik, J. G. (2014). A randomized trial of epidural glucocorticoid injections for spinal stenosis. The New England Journal of Medicine, 371(1), 11-21. doi:10.1056/NEJMoa131326. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMx140040

Gagnier, J. J., Oltean, H., van Tulder, M. W., Berman, B. M., Bombardier, C., & Robbins, C. B. (2015). Herbal medicine for low back pain- a Cochrane review. Spine, Publish Ahead of Print. doi:10.1097/BRS.0000000000001310. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26630428