Article: Pharmacological alternatives for the alleviation of back pain.

Author(s): Bogduk N.

Journal: Expert Opinion on Pharmacotherapy.; 2004 Oct;5(10) p2091 - 2098

Drugs constitute a convenient option for low back pain and are commonly used. However, evidence for their efficacy is meagre. Many drugs used for back pain are no more, or only slightly more, effective than placebos. Others have side effects that outweigh their usefulness in relieving pain. On the basis of the evidence, no drug regimen can be legitimately recommended for back pain. The management of back pain requires measures other than drugs. One exception is the use of willow (Salix) bark for acute exacerbation of pain. Ironically, for chronic low back pain, the most effective and long-lasting outcomes have been documented for normal saline by injection into tender points in the lumbar spine. (Emphasis added)

Dr. Goodman's comment: The author is a well known researcher in spine pain. His stated opinion regarding drugs speaks for itself. Because normal saline is salt water, the (mistaken) conclusion is often reached that trigger point saline injections work through the placebo effect, rather than the well documented effect of the needle itself. Indeed, other studies have repeatedly confirmed that the injection of normal saline (or lidocaine/steroid) offers no additional benefit (and potential harm in the case of lidocaine/steroid) over 'dry' needling and the more comprehensive approach of IMS.