What is the Right Medication for Your Back Pain?

When it comes to back pain medications, you have options—a lot of them. How do you know which one is right for you?

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Back pain—and the medications that treat it—is almost as varied as the people who have it. For some people, the pain is minor and over-the-counter (OTC) treatments work just fine. For others, managing pain requires more than OTC medications can provide. So what do you do? You call the pros. Working with your doctor or medical professionals who specialize in pain management can help you find the right meds.

Man taking back pain medicationWhat's the best medication for your back pain?

What Medications Are Out There for Back Pain?

First thing’s first: Medication isn’t remotely the only treatment for back pain. In fact, most cases of back pain resolve (go away) by themselves in a matter of weeks. But for those cases that don’t, there’s a wealth of options both surgical and nonsurgical. Exercise and physical therapy, epidural steroid injections, decompression surgeries and, yes, medications: All are potentially on the table, depending on what’s causing your back pain.

When it comes to back pain medication, there are several classes of drugs that treat pain. Non-steroidal anti-inflammatory drugs, commonly called NSAIDs, are often the first line of defense. NSAIDs are available over the counter or by prescription. There are also antispasmodics, drugs that specifically treat muscle spasms often accompany back and spine injuries.

Sheri Dewan, MD, a neurosurgeon at Northwestern Medicine Regional Medical Group in Winfield, IL, explains further. “There’s any number of pain medications which include non-steroidal anti-inflammatories—so that would be like your Aleve, aspirin, Motrin. Then there are other medications that are narcotic medications, [such as Norco or Tylenol Number Three, which is with codeine… And then there’s your anti-spasm medications which are things like Flexeril and Valium. And so we use essentially three classes of medications to treat back pain.”

NSAIDs

As mentioned above, NSAIDs are available OTC, such as ibuprofen (brand name Advil) or naproxen (brand name Aleve). NSAIDs are also available in prescription doses, which contain higher levels of the chemicals used to fight pain. NSAIDs are common in treating joint pain, explains Dr. Dewan, “If patients have more back pain that’s more joint-related or arthritic in nature, we can put them on NSAIDs.”

Puja Shah, MD, a double board-certified anesthesiologist and interventional pain management specialist at DISC Sports and Spine Center in Newport Beach, CA , explains that NSAIDs work in receptors in the body  to help decrease prostaglandins, lipids that form where there is tissue damage or infection and cause inflammation. “If somebody is having pain and inflammation such as a recent joint injury, a headache or pain from a recent fall, they can utilize [NSAIDs] to decrease inflammation.”

Some patients, particularly those with gastrointestinal or cardiovascular issues, can’t take NSAIDs because of side effects. These side effects can include GI distress, kidney function issues and tolerance with use over time. Since NSAIDs are a valuable and common medication for back and spine pain, though, it’s best to discuss them with your doctor to see if your need for this class of medication outweighs potential risk. Alternately, your doctor may prescribe acetaminophen (brand name Tylenol), also available OTC .

Antispasmodics

Many people with back and spine injuries know how painful muscle spasms can be. This kind of pain happens when the muscles in your back and around your bones involuntarily contract or tighten. Muscle spasms are thought to be the top cause of back pain, especially the kind of back pain that goes away on its own after a few weeks. They also run the gamut to mild inconvenience to intense pain and you might not want to wait it out, so it’s important to have the right medication to treat them.

Anti-spasm medications are things like Flexeril [cyclobenzaprine] and Valium [diazepam],” says Dr. Dewan. These medications work directly on the central nervous system. There are two types of antispasmodics. Benzodiazepines, sometimes abbreviated as “benzos,” block chemicals in the brain to treat pain. Nonbenzodiazepines, also called Z-drugs, work on both the brain and the spinal cord to reduce or prevent pain.

Both benzodiazepines and nonbenzodiazepines are considered sedatives or sedative hypnotics. They also both have an addictive profile and are generally only recommended for short-term use. Additionally, these kinds of medications have side effects including drowsiness, dizziness, and sleep issues. Care should be taken when using antispasmodics.

Opioids

Opiods are a class of medication that work to block pain signals in the brain. Common prescription opioids include oxycodone (Oxycontin) and hydrocodone (Vicodin). These drugs are highly addictive because they release endorphins, neurotransmitters in the brain that make you feel good. But opioids are also highly effective pain killers, especially post-surgery.

“I do believe that opioids are needed and useful for situations of post-surgical pain,” says Dr. Dewan. She adds that patients should only use opioids for short periods. “In our office, we write for opioid prescriptions for up to 90 days post-surgery [where] there is a significant amount of pain with muscle dissection and opening up an incision. I like all of my patients to be getting off of opioids within three months post-surgery, especially for spinal fusion. In some instances, if it’s a situation like a micro-discectomy or a small spinal surgery, they should be off of all opioid therapy within days.”

Dr. Shah agrees. “At this time, opioid medications are the strongest pain medications that we have, given that they directly attach to our innate opioid receptors, leading to analgesia… In fact, after most surgeries, patients are prescribed opioids via IV in the recovery room and often for a week or two post-surgery, given that pain scores are usually at an all-time high post-procedure.”

Opioids should only be used for short periods and only as directed by your doctor. “Physicians are now discouraged to start patients on opioid use for chronic conditions such as pain lasting for greater than three months because it has been shown by research that opioids for long term will only continue to cause increased dependence and tolerability in patients, requiring higher and higher doses,” explains Dr. Shah. “Hopefully, with the understanding of this by both physicians and patients, we can lead to less opioid-related overdoses, as well as an understanding of the importance of a multi-disciplinary approach to chronic pain.”

If you have concerns about your opioid prescription or use, contact your doctor or contact the Substance Abuse and Mental Health Services 800-662-HELP or visit their website.

 

Updated on: 06/02/21
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Puja Shah, MD
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