We all know some people who fake back pain but, as a onetime sufferer myself I know it can be excruciating and very real if sometimes difficult for doctors to diagnose and very difficult to treat. Recent studies show that a back injury can alter brain structure and that an existing drug (not a pain reliever) can help.
Doctors know that many people complaining of back pain are really suffering even though no real cause can be found on x-rays – even worse, the usual battery of pain relievers from NSAIDs to mild narcotics don’t offer much relief.
The BackCare Journal states, “The overarching message that arises from the clinical trials of treatments for chronic low back pain is that current interventions provide only small short term benefits when compared to sham treatment or no treatment.”
But there is new hope and a powerful one. The Journal of Neuroscience, vol 26, p 12165 carries a report by A. V. Apkarian, Dept. of Physiology, Northwestern U. School of Medicine which explains that chronic back pain can lead to changes in the brain making the individual more sensitive to the pain. “”The brain is reorganising in these patients. It amplifies the pain signal.”
The important implications include the discovery that low doses cycloserine, an antibiotic used to treat tuberculosis (mycobacterium or MAP infections), dampens activity in that part of the brain in rats.
Human clinical trials are beginning soon, but those can take a decade or longer and, since this is an existing drug and the effective dose for reducing back pain is one-fifth the safe dose for treating TB, some patients may wish to let their doctor know about these results and try treatment called off-label, which is perfectly legal and only means using an existing drug to treat something it wasn’t originally developed to treat.
All drugs have side-effects, but one which many people are already taking in higher doses are more likely to be safe than a new drug, especially in treating pain which isn’t effectively managed by analgesics.
Chronic pain which can’t be managed using analgesics is of particular concern because people are prone to taking larger doses of dangerous pain killers in an attempt to get relief.
Although people in great pain can tolerate narcotic doses which are normally fatal – when the narcotics work, I know of no studies showing whether this is also true when the narcotics don’t provide any real relief which is sometimes the case with chronic back pain. Knowing that the pain can cause physical alterations in the brain explains why narcotics, which act by blocking certain chemical signals in the brain, aren’t effective in those cases.