Back and neck pain is reaching what some experts call epidemic proportions worldwide, but are scientists any closer to finding a “Holy Grail” of medicines for safe, long-term relief?
“Quite possibly,” says interventional pain management specialist Kaliq Chang MD of the New York and New Jersey based Atlantic Spine Center. He cites the latest study results, released in June 2020, indicating that a new, injectable drug, Tanezumab, a monoclonal antibody, may offer extended reduction of chronic lower back and neck pain and improve movement and function by blocking action of a specific protein – a nerve growth factor.
“If eventually approved by the FDA, this medication could prove a welcome alternative to opioids, such as morphine and oxycodone, which are addictive with potentially life-threatening side effects, and to non-steroidal anti-inflammatory drugs like ibuprofen, acetaminophen and aspirin whose effects are often limited and may be deemed inadequate by the patient,” says Dr. Chang.
He agrees with the Agency for Health Research and Quality, that, for too long, use of opioids has been an “easy remedy” for both acute and chronic pain and has “fueled the current opioid crisis” in the United States. In fact, abuse of prescription opioids is considered a major risk for heroin use.
Dr. Chang also notes a 2018 report in the Journal of the American Medical Association indicating that chronic pain patients given opioid medications fared no better than those on non-opioid drugs. The study involved 240 randomized patients, many of whom suffered back pain.
Neck and back pain are considered leading causes globally for long-term disability, lost work days and the expenditure of literally billions of health care dollars and the third most common reason why patients in the United States visit the doctor’s office. Among causes of such pain are degeneration of vertebrae, primarily due to osteoarthritis, osteoporosis and other effects of aging; structural problems of the spine, including herniated discs that pinch nerves, and stenosis, a narrowing of the spinal column; continuous overuse or improper use of neck and back muscles; injury; and lifestyle issues, such as obesity and smoking.
Chronic pain, in general, affects some 40 percent of the U.S. population. Yet, experts decry the lack of new drug development for pain management and the dearth of long-term studies to find proven non-pharmacologic therapies for treating neck and back pain. As one leading researcher at the University of Rochester School of Medicine put it: there has not been a drug “in maybe 100 years developed with a new way of affecting chronic pain.”
But the medication drought could be ending, Dr. Chang says. He points to a 2019 study in Science Advances, in which scientists from the University of Bonn (Germany) announce discovery of how opioids bind to three of the body’s pain receptors (special sensory neurons). They indicate that developing drugs targeting only one of these receptors (DOP) could prevent addiction and serious side effects, including respiratory paralysis.
Another scientific group from Thomas Jefferson University in Philadelphia has published findings identifying a physiologic process that changes the function of a pain receptor, thereby causing cellular dysfunction and a higher sensitivity to pain. The researchers suggest drugs might be developed to block this process.
Of course, until some new wonder medication appears on the horizon, pain management specialists must continue relying on the pharmacologic tools at hand, Dr. Chang states. For both neck and back pain, these tools include first-line over-the-counter agents such as analgesics for pain relief, non-steroidal anti-inflammatory medications, and topical applications in the form of creams, gels, and ointments. Among prescribed medications are muscle relaxants; drugs that address nerve-related pain; anti-depressants to enhance production of the body’s natural pain killers(endorphins); orally taken corticosteroids; and, when absolutely necessary, opioids.
If pharmacologic and physical therapy approaches fail to mitigate pain, spinal and cervical drug injections can be a non-surgical option, Dr. Chang explains. Injections may be used to target a specific spinal nerve or treat pain in the sacroiliac joint (where the spine connects to the pelvis). Injectables also may relieve pain in a facet joint (found between nearly every pair of vertebrae) or to deposit drugs such as corticosteroids in the epidural spaces around the spine. Also successful in many chronic cases is the application of radiofrequency to heat an affected nerve, creating a lesion that prevents the nerve from continuing to transmit pain.
The best medicine, of course, is prevention. That is why Dr. Chang offers these tips to avoid developing chronic neck or back pain:
- Give a painful neck time to heal. Do not make quick, sudden head movements. Wear a cervical collar if necessary.
- Use proper lifting techniques for heavy or cumbersome items. That means keep the object close to the body and lift with the knees.
- Remain active and warm up and stretch before engaging in any exercises.
- Take frequent breaks when work requires constant stress on back, shoulder and neck muscles
- Sleep with your head on one pillow – not elevated on two or three.
- Maintain proper body posture. Walk or sit erect, back and shoulders straight.
- Follow a healthy lifestyle. That means get down to a proper weight and stop smoking.
And, if back or neck pain does develop and fails to respond to home remedies, contact an orthopedic or interventional pain management specialist as soon as possible to avoid it becoming a greater problem in the future, Dr. Chang advises.