New diazepam amitriptyline pregabalin warning over treating ailment suffered by 10 million in UK

New diazepam amitriptyline pregabalin warning over treating ailment suffered by 10 million in UK Doctor who has appeared on BBC Breakfast, Good Morning Britain and Lorraine said 'you're probably treating it wrong' A TV doctor has said that people need to avoid certain drugs for back pain - as it either won’t work or could make it worse. Over 10 million adults in the UK suffer from back pain annually. More than half of all British adults (around 58%) will experience low back pain at some point in their lives, making it a leading cause of long-term sickness and disability across the country. Doctor Mark Porter, who has appeared on BBC Breakfast, Good Morning Britain and Lorraine is a GP and he said the way people manage the condition is imply wrong - with many doctors ignoring guidelines. He said: “Despite long-established UK guidelines on best practice, which have just been updated by the National Institute for Health and Care Excellence (Nice), we are still making the same mistakes. Put simply, too many people are doing the wrong thing, taking the wrong medication or having the wrong investigations.” He said a recent study of consultations at a GP surgery in Glasgow found that guidelines were not followed in six out of ten cases. Dr Porter wrote in the Times : “It was a small sample and impossible to extrapolate to the whole UK, but it reflects data from other studies, including another recent one based on emergency department attendance in the US. This found similar divergence from the guidelines, with one in five people given opioid painkillers such as codeine and morphine (these should be avoided in back pain where possible) and too many (nearly 40 per cent) having spinal x-rays that were unlikely to help.” Dr Porter said there are a number of things people should avoid when trying to treat a bad back. These incluide: “Avoid supportive belts, corsets, corrective shoe insoles, Tens (transcutaneous electrical nerve stimulation) machines and acupuncture, and don’t rely on paracetamol. It’s generally harmless if you stick to the right dose, but research shows that it doesn’t work for this type of pain. Nice also recommends avoiding opioid painkillers except where other drugs don’t help. Opioids often don’t work that well, and may even result in worse long-term outcomes, not least opioid dependence, which can leave people still in pain but addicted and sedated. Nice also advises against medicines to help with short-term nerve pain such as the old-fashioned antidepressant amitriptyline and newer drugs such as pregabalin and gabapentin (amitriptyline is still used to treat chronic pain). For sciatica — nerve pain, typically in the leg — we should not be using diazepam.” He said the painkillers of choice for acute back pain are the non-steroidal anti-inflammatory drugs (NSAIDs): “If you are self-treating it will be ibuprofen, which is available over the counter, but if under the care of a doctor it will probably be naproxen.” NSAIDs can cause serious side-effects, including kidney problems and life-threatening stomach bleeds, so they are often prescribed alongside something to protect the stomach, such as the acid-suppressing drug omeprazole. He said there are also investigative methods which people shouldn’t expect: “Do not expect an x-ray or scan. There are situations where they are important but, in general, they don’t help and, in the case of x-rays, expose you to unnecessary radiation. MRIs don’t involve ionising radiation so are safer, but are expensive, often pick up irrelevant wear and tear, and are not always helpful. “Don’t push for surgery. This is rarely offered in acute back pain but can be an option for some people, including those with severe sciatica. I underwent a microdiscectomy 20 years ago having been in agony for months with a weak left leg. It worked a treat, but long-term outcomes for those who have this type of surgery for a prolapsed disc are often no better than they are for those who heal naturally, so avoid it if you can. I still have occasional sciatica now.” He said people should try to keep active, go to work but resting could lead to weakness and an overall slower recovery. Dr Porter added: “As a rule people who remain active, and at work, tend to fare better. And consider an active exercise programme. “To summarise: if you develop back pain after some DIY next weekend, assuming you don’t have any ofthe red flags below, current advice would be to take ibuprofen, stay as active as possible and head off to work as usual on Monday. Most cases improve gradually within 4–6 weeks, but if yours hasn’t, see your GP.”