FRIDAY, Nov. 9 (HealthDay News) -- Two widely used treatments for acute low back pain -- nonsteroidal anti-inflammatory drugs (NSAIDs) and spinal manipulation -- did not help patients in a carefully controlled study, Australian researchers report.

That's not especially surprising, American specialists said, because the evidence for their effectiveness has never been overwhelming. In fact, new recommendations for treating lower back pain take the lack of effectiveness of these treatments into account.

However, this is one of very few studies to provide solid documentation of what happens -- or doesn't -- with the treatments, the experts said.

"They just don't work better than placebo control," said Dr. Todd J. Albert, professor of orthopedic surgery and neurosurgery at Jefferson Medical College, who was not involved in the research. "But they are two common things that physicians do all the time. Patients come to a hospital feeling entitled to a treatment, and doctors feel they have to treat," he said.

The Australian study, done at the University of Sydney, included 240 people who had been treated with acetaminophen for low back pain without getting major relief. They were divided into four groups -- one getting the NSAID diclofenac (sold as Voltaren) at 100 milligrams per day and manipulative therapy, another getting the drug and a fake manipulative therapy, a third getting real manipulative therapy and a placebo drug, and the fourth getting a placebo drug and the fake manipulative therapy.

"Neither diclofenac nor spinal manipulative therapy gave clinically useful effects on the primary outcome of time to recovery," the researchers report in the Nov. 10 issue of The Lancet.

New guidelines just issued by the American College of Physicians and the American Pain Society already advise against general use of the two therapies, noted Dr. Daniel Mazanec, associate director of the Cleveland Clinic Center for Spinal Health.

"For this group of patients, with acute nonspecific low back pain with an average duration of nine days, the guidelines recommend the importance of staying active and [taking] relatively simple painkillers such as acetaminophen," Mazanec said.

Still, "this is the first study in a well-characterized group of patients to support the guidelines," he said.

The potential side effects of NSAIDs make avoiding them advisable if possible, Albert said. But one or another of them may still be used in individual cases, since different people may get some relief from one NSAID but not another, he said.

"There is individuality to response," he said.

Other NSAIDs include aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve).

While diclofenac did not speed the progression to recovery from pain, "that doesn't mean it should not be used, because it may make patients more comfortable along the way," Albert said.

Side effects of NSAID treatment in the study included gastrointestinal disturbances, dizziness and heart palpitations. However, the incidence of such side effects was about the same in the group getting the placebo drug treatment, the researchers noted.

More information

There's more on back pain at the U.S. National Library of Medicine.

MONDAY, Nov. 26 (HealthDay News) -- Premenopausal women struggling with depression have lower bone mass than do non-depressed women in the same age range, a new study found.

The bone loss was most pronounced in certain regions of the hip, which is troubling given that hip fractures are one of the most serious -- and potentially fatal -- consequences of osteoporosis.

The level of bone loss seen in the depressed women was the same or higher than that associated with other, established risk factors for osteoporosis, including smoking, low calcium intake and lack of physical exercise, the researchers said.

The findings, published in the Nov. 26 issue of the Archives of Internal Medicine, could have implications for the prevention of osteoporosis.

"Premenopausal women with depression should be screened for low bone mass," said Dr. Giovanni Cizza, senior author of the study who conducted the research while at the U.S. National Institute of Mental Health. "They should do a bone mineral density measurement, because osteoporosis is a silent condition. Until someone fractures, you don't know you have osteoporosis."

Cizza is now a staff clinician at the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

A woman's bone mass peaks during youth then thins after menopause. Previous, preliminary studies had suggested that depression might be a risk factor for low bone mass in older women.

For this study, Cizza and his colleagues looked at 89 women with depression and 44 women without depression. The women ranged in age from 21 to 45. The depressed women were taking antidepressant medications.

Seventeen percent of the depressed women had thinner bone density in the femoral neck, a vulnerable part of the hip. Only 2 percent of non-depressed women, by contrast, had thinner bone in this area.

Twenty percent of depressed women also had low bone density in the lumbar spine, compared with 9 percent of the non-depressed women.

Blood and urine samples also revealed that the depressed women had lower levels of "good" proteins called cytokines. "The bad cytokines that may cause bone loss are higher," Cizza said.

It's not clear what role antidepressants might play, but by relieving the depression, the drugs may also help bone mineral density, the researchers said.

More information

To learn more about bone health, visit the National Osteoporosis Foundation  .

MONDAY, Nov. 26 (HealthDay News) -- Combining an older synthetic drug with a newer, "biologic" medication may work best to ease the joint swelling and tenderness of rheumatoid arthritis, a new study finds.

There are many therapies for rheumatoid arthritis, but the newer drugs are not better than older ones when used alone, the report's authors found.

"There are no clinically important differences among the older synthetic drugs or among the newer biologic drugs," said lead researcher Dr. Katrina E. Donahue, an assistant professor in the department of family medicine at the University of North Carolina, Chapel Hill. "There are combination therapies that do work better than using one drug in people not responding to one drug alone," she said.

Combining a synthetic with a biologic appears to work best, Donahue said. However, which combinations are most effective still isn't clear. In addition, the short-term side effects appear to be the same for both types of drugs, she added.

In the study, Donahue's team reviewed 23 published studies that compared the benefits and harms of different rheumatoid arthritis drugs. These included, synthetic disease-modifying antirheumatic drugs (DMARDs), biologic DMARDs, and corticosteroids.

Synthetic DMARDs include hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate (Trexall) and sulfasalazine (Azulfidine). Biologic DMARDs include abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), etanercept (Enbrel), infliximab (Remicade) and rituximab (Rituxan). Corticosteroids include drugs such as prednisone.

Donahue's group found that combining methotrexate with a biologic DMARD worked better than methotrexate or a biologic alone. They also found that methotrexate was as effective as the biologics adalimumab and etanercept in early rheumatoid arthritis.

Adalimumab and etanercept had better short-term results. However, biologics and methotrexate boost the risk of serious infection, including a reoccurrence of tuberculosis, the researchers found.

Donahue's team also found that prednisone, along with hydroxychloroquine, methotrexate or sulfasalazine worked better in reducing joint swelling and tenderness than using a synthetic DMARD alone.

There was no difference in effectiveness between the synthetic DMARDs methotrexate, leflunomide and sulfasalazine. And combining methotrexate and sulfasalazine was no more effective than using either one of the drugs alone.

There was also not enough evidence to say whether combining two biologics was more effective than using one biologic, Donahue said. For every 1,000 people taking a biologic for three to 12 months, 17 have a serious infection and combining two biologics can increase that risk, the researchers noted.

In addition, rates of painful injection site reactions are more common for anakinra (67 percent) than for etanercept (22 percent) or adalimumab (18 percent), Donahue's group found.

Donahue recommended that patients talk to their doctors about developing a treatment plan that is tailored to their individual condition. "Rheumatoid arthritis is very patient-specific -- there are many therapies, and there doesn't appear to be one therapy that is clearly superior," she said. "It's a conversation between you and your rheumatologist about what might be right for you."

One expert said the study will be useful for physicians.

"This is a great summary about what we know about how DMARDs work," said Dr. Steven Vlad, a fellow in rheumatology at Boston University Medical Center. "That basic finding -- that one synthetic of biologic doesn't work any better than others -- is a good thing to remind ourselves of," he said.

Some doctors think that biologics work better, Vlad said. "But that's not the case. All these drugs seem to work equally as well," he said.

Combination therapy can be effective, Vlad said, but biologics should be the last choice. "Methotrexate is what most doctors are going to go with first," he said. "You start with methotrexate. If that doesn't work, you add another synthetic drug; if that doesn't work, maybe then you go to a biologic," he said.

More information

For more on rheumatoid arthritis, visit the Arthritis Foundation  .