Drugs, Medications, and Injections for Spondylosis
Once you've been diagnosed with spondylosis, one of the first treatments your doctor may have you try is medications. What he or she suggests depends on the severity of your pain and other symptoms. Most likely, the doctor will recommend a progression of medications, trying over-the-counter medications first. If those don't work to sufficiently relieve your pain, your doctor may prescribe stronger medications. If those still don't help, you may have a spinal injection, which sends a stronger medication directly to the source of your pain.
Over-the-Counter Medications for Spondylosis
- 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—and that inflammation plays a big part in spondylosis. Acetaminophen works by essentially blocking your brain's perception of pain, and it's good for pain flare-ups that may come with spondylosis.
- 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 naproxen (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.
Prescription Medications for Spondylosis
- Muscle relaxants: Because of the anatomical changes to your spine from spondylosis, your muscles may have to work harder to support the spine. Sometimes, your muscles can have spasms as they become overworked. 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.
- Opioids (narcotics): In the most extreme cases, and only under careful supervision, you 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 (eg, Celebrex). That's a type of NSAID, but it doesn't cause gastrointestinal side effects as other prescription NSAIDs can.
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 Spondylosis
- Epidural steroid injection: This is one of the most common injections. It's especially effective for low back pain caused by a herniated disc, another spinal condition that can develop because of spondylosis. An epidural steroid injection 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. It usually takes 2 to 3 days for the epidural steroid injection to take full effect.
Sometimes a local anesthetic is given along with the steroid medication to provide immediate pain relief while the epidural takes effect. This is called a "block."
An epidural steroid injection 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—as they are in spondylosis. The spinal facet joints help you move easily, plus they stabilize your spine. Inflammation of the facet joints caused by spondylosis can cause pain. A facet joint injection will numb the joint and can reduce your pain.