Back pain is one of the most pervasive, persistent, and difficult medical conditions to treat. Patients spend huge amounts of money on chiropractors and massage therapists to deal with the pain. There is a small army of surgeons, both orthopedic and neurosurgeons, who do surgical procedures to try to alleviate chronic back pain.

Hospitals often have special departments that specialize in spine surgery, most of which is related to the lumbar spine. And, of course, government agencies dealing with workers compensation devote much of their resources to evaluating and approving treatment for back problems, and spend large resources to make up for the workers’ missed pay. Finally, there is the human cost involved in people being in chronic pain that severely impacts their lives and that of their families. Economists have come up with estimates of billions of dollars lost in worker productivity.

It is not surprising that many people have looked for simple medical solutions to the problem. And that primarily consists of nonsteroidal anti-inflammatory drugs (NSAIDs). A recent study, however, found that such drugs really do not help much, if at all. Compared with placebos, the study found little clinical evidence that NSAIDS were effective.

Dr. Charles Kim at the NYU Langone Medical Center in New York believes this is true because there are so many diverse causes for back pain. “Every few years a study like this pops up saying that there’s little or no help for back pain with NSAIDs, acetaminophen, surgery, injections, physical therapy, or yoga.”

Dr. Kim believes that pain is probably the most complex problem encountered in medicine: “it can be due to a whole slew of things, whether it’s inflammatory, a muscle pull, a mechanical problem, or arthritis in the spine.” He went on to say “there are whole textbooks on the diagnosis of back pain — it’s a very nebulous diagnosis.”

The study that found little efficacy for NSAIDs in treating chronic back pain also included a systematic literature review of other trials of such drugs in treating neck pain, acute or chronic low back pain, and sciatica. The outcome: no evidence that showed a clinically important difference. The disabilities and life impact of back pain remains a major problem in our society with no clear solution, either medically or surgically.