Drugs, Medications, and Spinal Injections for Degenerative Disc Disease
Your doctor may suggest taking medications to help deal with the pain from degenerative disc disease (DDD). The severity of your symptoms determines what medications you may need, and it also makes a difference if your pain is acute or chronic. Acute pain is also called a flare-up; it's a sudden onset of pain. Chronic pain is long-term, and as degenerative disc disease progresses, you're more likely to have chronic pain than acute pain.
As with any drugs or medications, you shouldn't take anything without first consulting your doctor to see if it's the best option for you. Most likely, you'll go through a progression of medications, first trying over-the-counter medications. If those don't work, your doctor may prescribe stronger medications. If those don't help, you may have spinal injections that send a stronger medication right to the source of your pain.
Over-the-Counter Medications for Degenerative Disc Disease
- Acetaminophen: Tylenol is an example of 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 a painkiller. It doesn't help reduce inflammation, though. Acetaminophen works by essentially blocking your brain's perception of pain, and it's good for those pain flare-ups that may come with DDD.
- Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs): 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 (eg, Advil), aspirin, or aproxen (eg, Aleve).
By taking an NSAID, you are building up an anti-inflammatory effect in your system, so it's necessary to take it for awhile. That is, NSAIDs won't be as effective if you take them just when you have pain. Because they build up in your body and work to limit inflammation, NSAIDs are better for chronic pain sufferers.
- 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 painkiller. Finally, anti-depressants can also help you sleep better, which can be a major concern for people in chronic pain.
- Muscle relaxants: If you have chronic back pain caused by muscle spasms, you may need a muscle relaxant, which should help stop the spasms. Muscle relaxants may also help you sleep. Valium is an example of a muscle relaxant.
- Neuropathic agents: If you have nerve pain, your doctor may prescribe a medication that specifically targets the nerves. Neurontin, Lyrica, and Cymbalta are 3 examples.
- Opioids (narcotics): In the most extreme cases, and only under careful supervision, your doctor may also prescribe an opioid, such as morphine or codeine. Vicodin and Percocet are examples of narcotics.
- Prescription NSAIDs: You can take stronger NSAIDs than the over-the-counter variety, if your doctor thinks this is best for your pain. For example, he or she may recommend a COX-2 inhibitor (Celebrex is an example). That's a type of NSAID, but it doesn't cause gastrointestinal side effects as with other prescription NSAIDs.
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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.
- Epidural steroid injection: This is one of the most common injections. It's especially effective for low back pain caused by a herniated disc, one of the associated conditions with DDD. An epidural steroid injection (ESI) 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 legs. If a nerve root is compressed (pinched) in the epidural space, you can have pain that travels down your back and into your legs (commonly called sciatica, although the technical medical term is radiculopathy).
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.
- Facet joint injection: Also known as facet blocks, facet joint injections are useful if your facet joints are causing pain. 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.