NSAIDS vs. Exercise

12 July 2018
The Study: Therapeutic efficacy of nonsteroidal anti-inflammatory drug therapy versus exercise therapy in patients with chronic nonspecific low back pain: a prospective study.

The Facts

  1. The study included 33 total subjects divided into two groups.
  2. According to the authors, “Therapy for chronic, nonspecific low back pain is mainly conservative: medication and/or exercise.”
  3. They indicate that exercise can improve function but its effect on pain is limited.
  4. They also acknowledge that NSAIDs can reduce inflammation (thus, pain) but can also produce side effects.
  5. The participating institution was the Aizu Medical Center Fukushima Medical University (a decent school not normally associated with conflicts of interest in research results).
  6. They compared the two types of care for treatment of chronic nonspecific low back pain: Exercise vs. NSAIDs.
  7. Patients were divided into an exercise group and a medication group.
  8. The exercise group had 18 subjects and the type of exercise was trunk muscle strengthening and stretching exercises.
  9. The NSAID groups contained 15 subjects.
  10. Both groups reported pain relief at 3 month follow up.
  11. “In patients with strictly defined CNLBP (chronic nonspecific low back pain), as defined using a diagnostic support tool designed for lumbar spinal stenosis, the therapeutic efficacy of NSAID therapy and exercise seemed to be almost equivalent with regard to pain relief. However, the QOL of the patients was statistically improved in the exercise group but not in the NSAID group during the initial 3 months of this study.” (emphasis ours)

 The Take Home Message

For chronic nonspecific low back pain (that constant achy, dull pain) exercise and taking NSAID pain relievers are basically equal.

For Quality of Life issues, the exercise group reported more improvement.  My problem with most (in fact, nearly all) exercise programs are 1) they are kinda boring and 2) the programs are generally mindless (they do not focus on exercises or routines that actually improve correct structural imbalances).  However, boring or not getting patients doing something is better than doing nothing.

In the end, Active always trumps Inactive.

Reference: Takahashi N, Omata JI, Iwabuchi M, Fukuda H, Shirdo O. Therapeutic efficacy of nonsteroidal anti-inflammatory drug therapy versus exercise therapy in patients with chronic nonspecific low back pain: a prospective study. Fukushima J Med Sci. 2017 Apr 28;63(1):8-15. doi: 10.5387/fms.2016-12. Epub 2017 Mar 22.

Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/28331155

Synopsis of Research Readings:  Dr. Gary Pribble, AdvanTech Chiropractic, 1000 23rd Street Bettendorf, Iowa (563) 355-2378

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