Drugs and Medications for Spondylolisthesis
If spondylolisthesis causes you pain, your doctor may recommend medication or injections.
Over-the-counter Medications for Spondylolisthesis
Most pain from spondylolisthesis can be handled with over-the-counter medications. You have 2 main options.
- Analgesics: These control pain; the layman's term for them is "painkillers." Acetaminophen—Tylenol—is an analgesic.
- Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs can help reduce inflammation (swelling) in addition to relieving pain. 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 Spondylolisthesis
If over-the-counter medications don't adequately relieve the pain, your doctor may give you a prescription for something stronger.
- Muscle relaxants: If you have chronic back pain caused by muscle spasms, you may need a muscle relaxant, which will help stop the spasms.
- Neuropathic agents: If you have nerve pain, your doctor may prescribe a medication that specifically targets the nerves. Neurontin and Lyrica are 2 examples.
- Opioids: In the most extreme cases, and only under careful supervision, you doctor may also prescribe an opioid, such as morphine or codeine.
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 or over-the-counter medications you're on.
Injections for Spondylolisthesis
Injections are the third option to deal with spondylolisthesis pain, but generally, your doctor won't recommend them until after you've tried over-the-counter and prescription medications. The most common injection used for spondylolisthesis is an epidural steroid injection (ESI).
An 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. The epidural steroid injection can also contain local anesthetics to provide some short-term and immediate pain relief while the stronger steroids start to take effect.
Another type of injection used for spondylolisthesis is a 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.
Finally, if you have chronic facet joint pain, your doctor may recommend radiofrequency rhizotomy, also known as facet ablation. Radiofrequency rhizotomy uses radio wave energy to stop the nerve's ability to transmit pain. It brings pain relief for anywhere from 9 months to 3 years, although most patients have about 1 year of pain relief. Radiofrequency rhizotomy is a pain management technique, so the doctor performing it should be specially trained.
Radiofrequency rhizotomy alone isn't the solution for chronic facet pain. During that period of pain relief, your doctor will probably have you in physical therapy. You will learn better posture and body mechanics, in addition to strengthening your spine's muscles. This should help you manage pain on your own by practicing healthy life habits.