Medications to Relieve Back Pain

Various medications may help treat back and neck pain, including acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, opioid analgesics, oral steroids, and anti-depressant medications. What will work for your pain? Talk to your doctor to determine your best over-the-counter and/or prescription drug option(s).
Acetaminophen boxes on a store shelfAcetaminophen is safe and its analgesic effects make it acceptable for acute low back pain. Acetaminophen
Acetaminophen is safe when used as directed, and its analgesic effects make it acceptable for acute low back pain. It is inexpensive, readily available, and bears few complications and risks. It is effective for mild to moderate pain, but it doesn’t treat inflammation and muscle spasm. Another drawback is that its efficacy for moderate to severe low back pain is questionable.

Often, patients try to obtain relief with acetaminophen prior to seeing a doctor. Though acetaminophen is readily available, it’s not without risks. The prolonged use of high-dose acetaminophen may cause serious health problems, including significant liver toxicity.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) are a first-line medication for low back pain. As the name implies, these medications offer anti-inflammatory properties. These anti-inflammatory benefits are most prominent during the first week after injury. The dosage to produce anti-inflammatory effects is significantly different than for their analgesic effects. Most NSAID usage achieves only analgesic effects, as the dose prescribed is often too small and too infrequent to produce an anti-inflammatory effect. By carefully prescribing therapeutic doses at regular intervals, patients may experience both analgesic and anti-inflammatory properties of these agents.

There are risks associated with NSAID use, especially in the elderly, in those with a history of peptic ulcer disease, hypertension, or renal insufficiency. Some NSAIDs, known as COX-2 inhibitors (celecoxib) pose a lower gastrointestinal risk. Even so, you should avoid prolonged use of these medications (greater than 4 weeks).

Muscle Relaxants
Muscle relaxants may help reduce low back pain, and they appear to have additional benefits when used with NSAIDs.

The term "muscle relaxant" is somewhat controversial, and these agents do not work at the muscular level. Common side effects include drowsiness and fatigue. The use of benzodiazepines (tranquilizers) does not appear to be helpful for patients with acute low back pain. There is some concern with long-term use of carisoprodol (Soma) as its active metabolite, meprobamate, has been associated with withdrawal symptoms.

Muscle relaxants can be used as short-term adjunctive medication—that is, used alongside another treatment. It is recommended that you use a muscle relaxant prior to bedtime to take advantage of the sedating effects and reduce daytime sedation.

Opioid Analgesics
The use of opioids in the treatment of low back pain should be limited to pain that is unresponsive to other medication, such as NSAIDs. Opiates may be prescribed to manage severe pain associated with disc herniation or other back injury. When prescribed, opioids should be used on a defined dosing schedule and not on an as-needed basis. Prolonged or repeated use of opioids is not recommended to treat low back pain, as serious side effects—including abuse and addiction—may develop.

Oral Steroids
Oral steroids have a strong anti-inflammatory effect, so they may ease radiculopathy caused by disc herniation. However, scientific evidence doesn’t show a strong link to oral steroids’ effectiveness in the acute low back pain population. The use of oral corticosteroids for people with low back pain requires further clinical research and a more complete understanding of potential side effects and risks.

Anti-depressant Medications
Anti-depressant medications are generally not necessary to treat acute low back pain. Tricyclic antidepressants (in particular, amitriptyline) have been well studied and supported as useful analgesics for people with nerve pain, but their use in treating acute low back pain is less clear. While more research on anti-depressants and low back pain is needed, these medications can be helpful for pain and sleep if used at bedtime. Doses should begin low and slowly increased to minimize side effects.

Updated on: 11/28/18
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