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Drugs, Medications, and Injections for Upper Back Pain

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Your upper back pain may require medications and / or spinal injections to reduce the pain. The doctor will need to make a diagnosis in order to best and most effectively treat your pain. Is it caused by a muscle problem? Is there a problem with your spinal joints? Is there inflammation?

With that information, the doctor can better prescribe medications or spinal injections. Medications and injections should always be part of a larger treatment plan that addresses the entire problem. Because medications and injections just treat the pain—and not the underlying cause of the pain—you need to use other treatment options to treat what's causing the pain.

The goal of medications and injections is to relieve your upper back pain enough so that you can go about your daily life and get other treatments for the underlying cause (eg, physical therapy).

There's a progression to medications and injections: You don't start with the highest dose of the strongest medicine. Instead, you'll probably start with over-the-counter medications. If those work to sufficiently relieve your pain, great. If they don't, the doctor may prescribe something stronger.

Injections are typically used as the last option because they use very powerful medications.

Over-the-Counter Medications for Upper Back Pain

  • Acetaminophen: Tylenol is an example of an acetaminophen, a type of medication that has proven to be a good pain reliever. Your doctor may call this an analgesic, but most of us refer to acetaminophen medications as painkillers. They don't help reduce inflammation, though.
  • Over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs): These will help reduce swelling (or inflammation) while relieving your pain; that's how NSAIDs differ from acetaminophen. If an over-the-counter NSAID is an option for you, you have plenty to choose from. You can use ibuprofen (Advil), aspirin, or Aleve.

Prescription Medications for Back Pain
If an over-the-counter medication doesn't work to relieve your upper back pain, the doctor may prescribe something stronger. Some possibilities for upper back pain are:

  • Anti-depressants: As surprising as it may seem, anti-depressants can be effective drugs for treating pain because they block pain messages on their way to the brain. They can also help increase your body's production of endorphins, a natural pain killer.
  • Muscle Relaxants: If you have upper back pain caused by muscle spasms, you may need a muscle relaxant, which will help stop the spasms.
  • Narcotics (Opioids): These are very serious medications, and they should be used only in the most extreme cases and under the careful supervision of your doctor. Opioids, also called narcotics, work to raise your threshold for pain. So even if your body is in a lot of pain, the opioid's effect on your brain convinces you that it's not that bad.

    The doctor can prescribe short-acting narcotics, such as oxycodone or Lortab, or he/she may prescribe long-acting narcotics, suh as Kadian or Oxycontin.
  • NSAIDs: Just like over-the-counter NSAIDs, prescription-strength NSAIDs reduce inflammation and relieve pain. By taking an NSAID, you build up on anti-inflammatory effect in your body—it's necessary to take an NSAID for awhile to see its full effects. That is, NSAIDs won't be as effective is you take them just when you have pain. NSAIDs are better for chronic upper back pain sufferers.

Medication Warning
As with all medications, you must follow your doctor's advice precisely. Never mix over-the-counter and prescribed drugs without consulting your doctor. Also, as your doctor decides what to prescribe, be sure to tell him or her if you're using any herbal supplements, in addition to any other prescription medications you're on.

Spinal Injections for Upper Back Pain
Injections are always used in conjunction with an exercise or physical therapy program. They should provide long-lasting pain relief so that you can work on strengthening your back and shoulder muscles to prevent recurrences of upper back pain.

  • Epidural Steroid Injection: This is one of the most common injections. It targets the epidural space, which is the space surrounding the membrane that covers the spine and nerve roots. Nerves travel through the epidural space and then branch out to other parts of your body, such as your chest and arms. If a nerve root is compressed (pinched) in the epidural space, you can have pain that travels into your arms and chest. That "travelling" pain is called radicular pain.

    An epidural steroid injection sends steroids—which are very strong anti-inflammatories—right to the nerve root that's inflamed. This is a pain management therapy, so it's best to have a well-trained pain management specialist do the injection. You'll probably need 2 to 3 injections; generally, you shouldn't have more than that because of the potential side effects of the steroids.
  • Other Injections: Depending on your diagnosis, your doctor may suggest other types of spinal injections. For example, you may have a facet joint injection. Facet joints in your spine help you move and provide stability. If they become inflamed, though, you'll have pain. A facet joint injection will numb the joint and can reduce your pain.

    You may also have a trigger point injection, which targets the part of the muscle that's irritate and causing pain or spasm.
Updated on: 09/07/12
Jason M. Highsmith, MD
This article was reviewed by Jason M. Highsmith, MD.
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