Heat packs and ibuprofen better for back pain than opioids, researchers say

Leah Dwyer, who became hooked after using the drugs to treat chronic neck pain, said: “When I took these pills, I felt quite like, ‘She’ll be right, I can handle this.’ It gives you a sense of euphoria and control. It’s opium – that’s the part I think people forget. They make you not care about the pain.”

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Eventually, Ms Dwyer was taking 15 pills a day. Her life came to revolve around them. But when she quit, she found the pain was not as bad as she had feared and easily treatable with Panadol.

The dangers of opioids are now well known. But patients in pain – and the doctors treating them – have a strong urge to treat, even if the evidence suggests in 95 per cent of cases patients presenting with back pain do not have serious underlying spinal damage.

Dr Machado’s solution: simple, cheap heat wraps. There is some evidence they are effective at treating back pain. Patients like them. And you cannot become addicted.

Over four months, Dr Machado’s University of Sydney team trained doctors and nurses at four NSW hospital emergency departments on best-practice guidelines for how to treat back pain, supplying boxes of heat wraps.

A study published on Thursday in BMJ Quality and Safety shows the intervention worked – to an extent. The proportion of patients given an opioid dropped from 62 per cent to 50 per cent, and the medical professionals’ skills at treating back pain improved.

But a second goal of the study – to reduce the number of patients sent for X-rays and MRIs – was unsuccessful.

About one-third of back pain patients who go to hospital are given imaging, despite evidence showing it does not help and can push patients towards surgery.

“It is a difficult problem to solve,” said Dr Machado. “We know patients with back pain want to be imaged, they want an X-ray, they ask for it. The doctor finds themselves in a very difficult situation.”

Dr Ashish Diwan, director of the department of orthopaedic surgery at Sydney’s St George Hospital, is a critic of guideline recommendations that advise against imaging for lower back pain.

“Imaging is costly but not doing them appears to be costlier as the incidence and prevalence of back pain continues to increase. The guidelines were developed when we did not have sufficient testing ability,” he said.

He said the new study showed the guidelines recommending against imaging “are not fit for purpose” as clinicians clearly “did not trust the guidelines”.