If You Have Chronic Back Pain, There is Now More Than One Way to Feel Like You're Floating On Air.

There are two major categories of back pain as I see it: legitimate and feigned. Unfortunately, whenever a research study involves patients who claim to have back pain, the investigator should be obliged to create some mechanism by means of which the fakers can be weaned out. The researchers, Salerno, Browning, and Jackson who authored the article entitled "The Effect of Antidepressant Treatment on Chronic Back Pain," which appeared in the January 14 2002 edition of the Archives of Internal Medicine, utilized a well-known method designed to circumvent the problem. They simply did their research by basing it on the work of others. In other words, they searched the literature for studies relating to the question and incorporated the findings into their own treatise. This is known as meta-analysis. The assumption, therefore, is that those responsible for the source studies utilized a reliable method in order to tell the real from the unreal or perhaps the imagined. In order to evaluate any such methodology for myself, I located the section in the article dealing with reasons for exclusion from the study. They included cardiac disease, urinary retention or renal disease, glaucoma, pregnancy, chronic obstructive pulmonary disease, and a history of substance abuse. I am sorry to say; there was no mention of any way to tell if a patient was lying . . . perhaps in an attempt to avoid working, or to sue for damages. Does this obviate the results? Not really. Since all nine trials chosen for the meta-analysis were both randomized and controlled, it can be assumed that there were approximately as many truth tellers in each group as there were liars. Naturally, the larger the number of subjects in a study the less likely will it be for lying to play a significant role. Thus, a very important calculation made by the authors stated, "Although our meta-analysis comprised nearly 30 years of research, there were only 287 patients studied in the active treatment groups and 252 in the control groups." The actual total was even less due to various reasons, being 504. Ouch! I may not be a statistician but that sure sounds like there may easily be a skewing of results here. If 29 patients were lying in the treatment group that's ten percent. If 50 patients were lying in the control group that's twenty percent. Let's face it, chronic back pain is a really bad condition to try to analyze unless you can prove that all the subjects had irrefutably demonstrable damage to their backs. Although the results of this meta-analysis are probably fairly accurate if we assume that the studies chosen for analysis were run by astute clinicians, there really does remain sufficient reason for caution in interpreting the conclusions.

So, what were the conclusions? A major finding was that pain severity improved with greater frequency in those patients treated with antidepressants compared to placebo. However, there is another obstacle here. A rather large number of treated patients had a second diagnosis of major depression. Let's face it. If you alleviate severe depression with an antidepressant, you are bound to have the patient claim that his or her back pain is better. Once again, we have to depend on the utilization of randomization and control groups and once again, we have an awful low number of participants for this technique to be reliable. When the researchers went one step further, it was found that there was no statistical difference between the treated and placebo groups, if activities of daily living were taken into account. Perhaps this points a finger at the idea that there may have been a fair number of liars included. After all, if someone is lying in order to avoid work or make some money, why would they want to admit that they can now lift up a briefcase or chop down a tree? One more interesting finding was as expected. The patients receiving antidepressants had more side effects. This is obvious since the placebo group was not actually getting any medicine.

Well, what does all this mean to you readers suffering from chronic back pain? Is it a good idea to ask your doctor to prescribe an antidepressant for you, if this is not already the case? Let's face it, when you really have severe back pain, and you're not faking it for some reason, any idea may sound great. The one question that remains is whether you wish to trade off relief from years of pain for the possibility of an addiction to a mind altering drug?