Managing Chronic Lower Back Pain: Exploring Bromelain for Inflammation Relief

Proliferative therapy. Lower back pain. Medication consultation?

Hello Doctor, three years ago I performed a barbell deadlift (knee bend deadlift) where I bent forward with the barbell on the ground, knees bent, and stood up holding the barbell.
When I returned the barbell to the ground, the weight was too heavy, resulting in an acute lower back strain.
At that time, there was bruising in my lower back, and I only experienced discomfort when bending over to lift heavy objects; otherwise, I felt fine while standing, sitting, or lying down.
However, since I underwent ultrasound-guided dextrose prolotherapy treatment at Far Eastern Memorial Hospital two years ago (10 injections in total), my lower back has been tight, uncomfortable, and occasionally feels sore and prickly whether I am standing, sitting, or lying down.
I am currently considering the study referenced in https://pubmed.ncbi.nlm.nih.gov/27470088/ regarding taking bromelain 500 mg/day for 16 weeks to alleviate the inflammatory response from the prolotherapy.
Is this feasible?

Mr. Li, 20~29 year old female. Ask Date: 2021/02/20

Dr. Yin Xinbei reply Rehabilitation

Bromelain 20,000 U, when combined with L-cysteine 20 mg, is primarily used clinically for the relief of swelling after surgery and trauma, as well as for mucolytic effects.
The recommended dosage is 3-6 capsules per day.
Nutritional supplements containing bromelain, typically at 500 mg, provide approximately 1000-1200 GDU (depending on the brand).
If U and GDU are considered equivalent, the dosage is relatively low, as it is a nutritional supplement and generally safe for consumption.
However, regarding efficacy, the journal in which this study was published has a low impact factor, indicating it is relatively easy to publish in.
The study results only show that after four weeks of use, bromelain's effectiveness is comparable to that of non-steroidal anti-inflammatory drugs (NSAIDs), but with fewer side effects.
After 16 weeks, there was a decrease in inflammatory markers, but there was no control group, meaning that the body could have achieved similar results through self-repair without any medication.
The comparison with the NSAID group after the first four weeks also presents similar issues; if comparing short-term use of 3-7 days, the NSAID group likely has a significant advantage.
Therefore, in clinical practice for acute sprains and swelling, physicians typically prescribe both, with bromelain as an adjunctive treatment, but they will definitely prescribe NSAIDs as well, rather than relying solely on bromelain.
Otherwise, patients may return the next day asking why the medication is ineffective.
In summary, you can purchase it as a nutritional supplement, but its efficacy is not guaranteed.

Reply Date: 2021/02/20

More Info

Managing chronic lower back pain can be a complex process, especially when previous treatments have not yielded satisfactory results. Your history of acute lower back injury from heavy lifting, followed by a glucosamine injection treatment, suggests that you may be dealing with ongoing inflammation or muscle tension that has not fully resolved. The introduction of bromelain as a potential supplement for inflammation relief is an interesting consideration.

Bromelain is an enzyme derived from pineapples, known for its anti-inflammatory properties. It has been studied for various conditions, including post-surgical swelling, sports injuries, and other inflammatory conditions. The study you referenced (https://pubmed.ncbi.nlm.nih.gov/27470088/) suggests that bromelain may help reduce inflammation and pain, particularly in the context of musculoskeletal injuries. However, it is essential to approach this with caution.

While bromelain is generally considered safe for most people when taken in appropriate doses, its efficacy can vary. The dosage you mentioned, 500 mg per day, is within the range often used in studies, but it is crucial to note that the results can be inconsistent. The study you referred to indicated that while bromelain showed some promise in reducing inflammation, it did not have a control group, which makes it difficult to ascertain whether the observed effects were due to the bromelain or simply the body's natural healing process over time.

In your case, since you have been experiencing persistent discomfort despite previous treatments, it may be beneficial to consider a multi-faceted approach. Here are several recommendations based on your situation:
1. Consultation with a Specialist: Given your ongoing symptoms, it may be wise to consult a pain management specialist or a physical therapist who can provide a comprehensive evaluation of your condition. They can assess your range of motion, strength, and any underlying issues that may contribute to your pain.

2. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles supporting your lower back, improve flexibility, and reduce pain. Therapists can provide tailored exercises that target specific muscle groups and address any imbalances.

3. Alternative Therapies: In addition to bromelain, you might explore other anti-inflammatory supplements, such as turmeric (curcumin), omega-3 fatty acids, or glucosamine, which may complement your treatment plan. Always discuss these with your healthcare provider before starting any new supplements.

4. Pain Management Techniques: Techniques such as acupuncture, chiropractic adjustments, or massage therapy may provide relief for chronic pain. These methods can help alleviate muscle tension and improve circulation in the affected areas.

5. Lifestyle Modifications: Incorporating regular low-impact exercises, such as walking, swimming, or cycling, can help maintain mobility and reduce stiffness. Additionally, practicing good posture and ergonomics during daily activities can prevent further strain on your back.

6. Monitoring Symptoms: Keep a detailed log of your symptoms, including when they occur, their intensity, and any activities that exacerbate or relieve them. This information can be invaluable for your healthcare provider in tailoring your treatment plan.

In summary, while bromelain may offer some benefits for inflammation relief, it should not be viewed as a standalone solution. A comprehensive approach that includes physical therapy, lifestyle changes, and possibly other supplements or treatments will likely yield the best results in managing your chronic lower back pain. Always consult with a healthcare professional before making any significant changes to your treatment plan.

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