Back Pain May Become Chronic with Overuse of Over-the-Counter Meds

common pain relievers may prolong back pain if used for several weeks straight

By Jonny Lupsha, Wondrium Staff Writer

Woman trying to relieve her lower back pain while working
A cycle of chronic back pain can develop from tensed muscles due to stress or overuse of muscles during a repetitive activity. Photo by StratfordProductions / Shutterstock

In a cruel twist of irony for those who suffer from back pain, a new medical study suggests that using common pain relievers to treat their condition for too long may be making things worse. Anti-inflammatories like ibuprofen are found in most medicine cabinets to relieve normal aches and pains, but researchers at McGill University found, in a study of 2,100 people, that back pain patients taking non-steroidal anti-inflammatory drugs (NSAIDs) developed chronic back pain at a rate nearly double that of those taking other drugs or no drugs at all.

Pain relievers notwithstanding, stress is a leading factor in chronic back pain. In his video series The Science of Mindfulness: A Research-Based Path to Well-Being, Dr. Ronald D. Siegel, Assistant Clinical Professor of Psychology at Harvard Medical School/Cambridge Health Alliance, discusses the link between the two.

How Does Stress Cause Back Pain?

The body’s autonomic nervous system has two branches: The parasympathetic branch tends to calm the body, while the sympathetic branch tends to arouse the body. When we believe we’re in danger, the sympathetic branch activates automatically. Stress is the activation of the sympathetic branch and another system, known as the HPA axis, which is short for hypothalamic pituitary access. According to Dr. Siegel, the HPA axis is a hormonal system similar to the sympathetic branch that simply activates a bit later.

These systems activate when we sense danger—the well-known “fight-or-flight response”—but eventually subside completely in primitive creatures. Humans aren’t always so lucky. Our capacities for abstract logic, anticipatory thought, and problem-solving set us up for chronic overarousal or disregulation of those systems.

“This involves back, neck, and other chronic muscle pain; gastrointestinal distress of all sorts […] and of course panic and other anxiety disorders,” Dr. Siegel said. “I’m not suggesting that all of these disorders are always caused by this over activation or disregulation of the fight-or-flight system, but all of these disorders can actually be caused entirely by these arousal patterns.”

Often, he said, they’re caused by an underlying medical component and exacerbated by the arousal component.

A Vicious Cycle

Chronic back pain caused by stress can almost begin without being noticeable, but it then snowballs into a real problem, in sort of a cycle. Dr. Siegel gave the example of snow shoveling. In many places, snow shoveling is not a year-round activity, so when a person suddenly has to do the repetitive physical motion of shoveling after many months without it, it can lead to overuse of the back muscles and short-term back pain.

“If the person is so unfortunate as to live in a country with a preexisting epidemic of chronic back pain, he or she may start to worry about the sensations of pain that arise in the back,” Dr. Siegel said. “When we start to worry, we start to have negative thoughts, and these thoughts bring with them fear. They may also bring with them a sense of frustration or even anger, and these negative emotions themselves affect the back.”

When fear, anger, or frustration strike, each of them involves a subconscious tensing of the muscles. Humans’ largest negative emotions all involve skeletal muscle tension. Of course, tense muscles get sore, and soreness leads to pain.

“Coming back to our cycle, tense muscles increase the sensation of back pain,” Dr. Siegel said. “This increased sensation of back pain increases the negative thoughts, and this goes off running and becomes a whole cycle.”

A clinical study of nonprescription medicines and chronic back pain will likely follow the initial study.

Edited by Angela Shoemaker, Wondrium Daily