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The Evidence-based Rap, or
What’s Wrong With My Pain Meds?

Home/Low Back Pain, Research, Safety/The Evidence-based Rap, or
What’s Wrong With My Pain Meds?

The Evidence-based Rap, or
What’s Wrong With My Pain Meds?

The Chiro.Org Blog

SOURCE:   A Chiro.Org Editorial

Based on:
  A Systematic Review on the Effectiveness of Pharmacological Interventions for Chronic Non-specific Low-back Pain ~ FULL TEXT
Eur Spine J. 2011 (Jan); 20 (1): 40–50

OK, maybe this isn’t a genuine Rap, and I’m not rhyming-Simon, but somebody needs to bust-a-cap on the pain-med industry, because they hold themselves to a much lower standard than they expect my profession to maintain.

Fortunately (and, to the rescue) comes this study from the Dutch Institute for Health Care Improvement. They actually *busted a cap*, by deciding to explore “the effectiveness of pharmacological interventions [i.e., non-steroid anti-inflammatory drugs (NSAIDs), muscle relaxants, antidepressants, and opioids] for non-specific chronic low-back pain (LBP)”. This article is a real eye-opener!

I say Bravo, because these drugs are medicine’s sole conservative approach for managing LBP. This Blog has previously published numerous (and recent) studies suggesting that chiropractic management for low back pain is orders of magnitude more effective for pain relief, and is also significantly more cost-effective than standard medical management. [1-8]

Now this study comes along challenging the benefits and effectiveness of medicine’s reliance on drug treatments for pain management. The Iatrogenic Injury Page [9] clearly documents the dangers associated with these drugs (primarily death).

This European Spine Journal study reviewed 17 randomized controlled trials for pain treatments:

NSAIDs (n = 4),
antidepressants (n = 5),
and opioids (n = 8).

Amazingly, no studies were found
for muscle relaxers!

The researchers concluded that NSAIDs and opioids “seem to lead to a somewhat higher relief in pain on the short term, as compared to placebo” (aka no treatment at all!), “in patients with non-specific chronic low back pain, and that both types of medication show more adverse effects than placebo”. (What an elegant understatement that is!)

Review of the Iatrogenic Injury Page clearly documents that tens of thousand of people die ever year from the use of NSAIDs for simple pain relief, and overdose deaths from prescribed opiates has doubled in the last 2 decades. [10]

Where are the headlines screaming about how routine medical pain-relief recommendations are killing patients in the tens of thousands???

When will this madness stop???

The current healthcare debate has brought up basic questions about how medicine should work. On one hand we have the medical establishment with its enormous cadre of M.D.s, medical schools, big pharma, and incredibly expensive hospital care. On the other we have the semi-condoned field of alternative medicine that attracts millions of patients a year and embraces literally thousands of treatment modalities not taught in medical school.

One side, mainstream medicine, promotes the notion that it alone should be considered “real” medicine, but more and more this claim is being exposed as an officially sanctioned myth. When scientific minds turn to tackling the complex business of healing the sick, they simultaneously warn us that it’s dangerous and foolish to look at integrative medicine, complementary and alternative medicine, or God forbid, indigenous medicine for answers.

Because these other modalities are enormously popular, mainstream medicine has made a few grudging concessions to the placebo effect, natural herbal remedies, and acupuncture over the years.

But M.D.s are still taught that other approaches are risky and inferior to their own training; they insist, year after year, that all we need are science-based procedures, and the huge spectrum of drugs upon which modern medicine depends. [11] And now, even that claim is eroding.


  1. New LBP Study Reveals Chiropractic Is Superior to PT and MD Care
    Chiro.Org Blog ~ 3-17-2011

  2. Chiropractic Cost-Effectiveness
    Chiro.Org Blog ~ 3-16-2011

  3. Chiropractic Goes To The Hospital
    Chiro.Org Blog ~ 3-06-2011

  4. Chiropractic Treatment of Workers’ Compensation Claimants in the State of Texas
    Chiro.Org Blog ~ 2-24-2011

  5. New Study Confirms That Maintenance Care Delivers!
    Chiro.Org Blog ~ 1-26-2011

  6. Primary Care MDs Decline Training In Pain Management
    Chiro.Org Blog ~ 1-20-2011

  7. The Cost-Effectiveness of Chiropractic Page

  8. Patient Satisfaction With Chiropractic Page

  9. The Iatrogenic Injury Page

  10. Painkiller Deaths Double in Ontario
    Chiro.Org Blog ~ 12-08-2009

  11. The Mythology Of Evidence-Based Medicine
    Chiro.Org Blog ~ 2-25-2011

About the Author:

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.


  1. […] The Evidence-based Rap, or What’s Wrong With My Pain Meds? […]

  2. Douglas Kennedy April 26, 2011 at 9:07 am

    Thank you so much for “pulling all the peer-reviewed Info together” for us. I love this site!

  3. Troy Holder, D.C. April 26, 2011 at 4:25 pm

    Great site! I love all the research that is being compiled at this site. Having just graduated from chiropractic college, its great to have all of this handy information at my finger tips without having to go to the library.


    Thanks Troy, but don’t stop going to the Library!

  4. karl May 3, 2011 at 7:13 pm

    Tuesday, May 3, 2011 (HealthDay News) — Few Americans bother to read the labels on over-the-counter pain relievers, nor do they pay much attention to the drugs’ ingredients, a new study says.

    This lack of awareness could be a main reason why acetaminophen overdose is a leading cause of acute liver failure in the United States, according to the researchers at Northwestern University in Chicago.

    Acetaminophen, the active ingredient in Tylenol, is in more than 600 over-the-counter (OTC) and prescription medicines.

    Researchers interviewed 45 people in six focus groups and found that only 31 percent knew that Tylenol contained acetaminophen, 19 percent realized Advil contained ibuprofen and about the same number knew that Aleve contained naproxen sodium.

    About 75 percent knew Bayer contained aspirin and 47 percent knew Motrin contained ibuprofen.

    Fewer than half — 41 percent — said they read the ingredients on drug labels.

    The study appears in the May 3 issue of the American Journal of Preventive Medicine.

    The fact that many people don’t know acetaminophen is present in OTC products is “incredibly alarming,” said senior author Michael Wolf, an associate professor of medicine at Northwestern University Feinberg School of Medicine.

    “People may unintentionally misuse these medicines to a point where they cause severe liver damage,” Wolf said in a university news release. “It’s easy to exceed the safe limit if people don’t realize how much acetaminophen they are taking. Unlike prescription products, there is no gatekeeper, no one monitoring how you take it.”

    This is why I believe there’s a reasonable argument for doctor’s of chiropractic to have the ability to talk with their patients about NSAIDs.

    RESPONSE from Frank:

    There is no regulation against DCs discussing drug use with patients. I do it every day. I’m just not licensed to prescribe drugs, and I am 100% OK with that.

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