American doctors’ freewheeling willingness to hand out opiate-based pain pills like party favors killed Prince and handed Donald Trump the White House. Now, with opiate sales quadrupling since 1999 and two million Americans hooked on pain pills—and Trump in nominal “control” of an America in which there is no Prince—doctors are suggesting that maybe they made a mistake. Maybe massage or acupuncture might have worked just as well as a pill.
Or, instead of highly addictive pharmaceuticals that would herald a return of cheap heroin, mindfulness and meditation—or a heat wrap. Just not pills. Try those last.
Vox picked up on a review from the American College of Physicians, published in the Annals of Internal Medicine on Tuesday, in which these non-pharmaceutical treatments for acute and chronic back pain were recommended over any kind of pill. Pills, and specifically opioids, should be a “last resort,” for a very obvious reason: They don’t really work.
In fact, according to the physicians’ article, there’s “moderate-quality evidence that strong opioids” are only marginally more effective than a placebo. Yes, the substance killing people and giving Donald Trump license to wage a new War on Drugs is just one hair more valuable to medicine than jellybeans.
Lower back pain is one of the most common reasons for Americans to seek medical attention as well as the leading reason why people miss work around the world, according to researchers. Conveniently, doctors also aren’t really sure what causes the most common form of lower back pain they see.
“Nonspecific low back pain” is not associated with an injury or a medical condition like osteoporosis or a pinched nerve, though as medical professor Roger Chou told Vox, people who are overweight, depressed, suffer from anxiety or smoke cigarettes tend to suffer from pain more often.
Pain can generally be divided into three categories, depending on length of suffering: acute (no more than four weeks), subacute (up to 12 weeks) or chronic (12 weeks or more). According to the review in Annals of Medicine, acute or subacute pain will “improve over time regardless of treatment.” For these patients, heat application should be tried first, then massage, acupuncture or maybe even a trip to the chiropractor. If that doesn’t work, only then should a patient turn to anti-inflammatory drugs like ibuprofen or a muscle relaxant.
Patients with chronic back pain should also try moving around first: “exercise,multidisciplinary rehabilitation, acupuncture, [and] mindfulness-based stress reduction” are all recommended ahead of pills. It may sound counter-intuitive to be told to stretch or work your back if it hurts, but apparently it works.
“Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients,” the researchers wrote.
Researchers do admit that the evidence supporting some of the “alternative” therapies, like yoga or tai chi, are thin (low to moderate, in their vernacular) and may not work for everyone. They also carry risk factors no more serious than an unused yoga mat rather than, say, the carnage of a rampant overdose crisis and a toxic margarine tub as president of the United States.
You may ask yourself: Why did it take us this long to come to this obvious conclusion? Surely it has nothing to do with opiates being a $24 billion market, with Americans—five percent of the world’s population—consuming 80 percent of the world’s pain pills.