The Centers for Disease Control and Prevention says that the most common type of pain is in the lower back, and that the very treatments used to soothe it might cause it to last longer.
The study found that managing pain with steroids and anti- inflammatory drugs can turn a wrenched back into a chronic condition.
Medical experts urged caution in interpreting the results. The gold standard for medical research is a clinical trial in which people with back pain are randomly assigned to take either a placebo or a non-steroidal anti-Inflammatory drug. Observations of patients, an animal study and an analysis of patients were involved.
It's intriguing but needs further study, said Steven J. Atlas, director of primary care practice-based research and quality improvement at Massachusetts General Hospital.
Dr. Bruce M. Vrooman, a pain specialist at a New Hampshire hospital, said that if the results hold up in a clinical trial, it could be an impressive study.
The director of Duke's pain therapies program had a different view.
People use the term "paradigm shift" but it is a paradigm shift.
Guidelines from professional medical societies say that people with back pain should start with nondrug treatments. The same side effects as pain-suppressing drugs are not present in those measures.
The guidelines say that people can try non-steroidal anti-Inflammatory drugs if the pain persists. It is not an anti- inflammatory because it does not block inflammation.
The study warned that drug treatment advice could contribute to chronic pain that would lower a person's quality of life.
The study began when researchers at the University of Montreal started looking for markers in the blood that would predict which patients would have pain that would quickly diminish and which would have pain that persisted.
The group took blood samples from 98 people when they first reported back pain and then again three months later.
The principal investigator of the study said that what they saw wasn't what they expected.
When the pain was acute, those who said their pain went away had rapid and intense inflammation. The markers of inflammation went down over the next three months. Those who had their pain persist did not have an inflammatory reaction.
There was absolutely nothing happening in those with chronic pain.
She said it was a huge difference.
The researchers continued to look into the matter. They studied people with temporomandibular joint disorders who had jaw pain. Those who recovered had rapid and intense inflammatory responses.
The sciatic nerves were compressed in mice to produce back and leg pain. The pain became chronic when they blocked the immune response with dexamethasone.
The group wondered if chronic pain came from suppression of inflammation or from suppression of pain. Some mice were given a prescription. Other mice were given one of the three other pain-relieving drugs.
The pain became chronic with diclofenac.
They wanted to know if patients who took non-steroidal anti-inflammatories like ibuprofen or steroids to relieve their back pain were more likely to develop chronic pain.
The UK Biobank contains information about half a million patients and is a repository for medical conditions and drug use. They studied 2,163 people with acute back pain, and 465 of them went on to have chronic pain. The researchers found that people who took a nonsteroidal anti- inflammatory drug had double the chance of developing chronic back pain.
She doesn't think her findings bear on the issue of addiction. She said that clinicians started to prescribe more non-steroidal anti-Inflammatory drugs to avoid opioids.
She said that they need to think about how to treat their patients.
Despite their poor performance, the tendency to use nonsteroidal anti-inflammatories persists. An analysis of randomized clinical trials found that the drugs had no effect on low back pain.
A new study shows that short term use of anti-inflammatories is not harmful, but it does not prove long term use is harmful.
Dr. Weinstein, senior vice president for health at Microsoft, wishes people would exercise instead of taking the pills.
Dr. Weinstein was editor in chief of the medical journal Spine for 28 years and says he goes out for a run when his back hurts. That makes it better.
He said that he knew the study was true.
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