Medications For Back Pain
- Acetaminophen
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
- Opioid pain medications
- Muscle Relaxants
- Antidepressants
- Anticonvulsants
There are many different types of non-prescription and prescription medications that can be helpful in relieving pain and addressing related symptoms while an episode of lower back pain is getting better.
Medications prescribed for back pain include:
- Acetaminophen
- NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
- Narcotic pain medications
- Muscle relaxants
- Antidepressants
- Anticonvulsants
The mainstay of pharmacologic therapy for acute low back pain is acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). If no medical contraindications are present, a two- to four-week course of medication at anti-inflammatory levels is suggested.
Acetaminophen (Tylenol) is the principle member of the group of drugs classified as para-aminophenol derivatives. While acetaminophen's analgesic and antipyretic (fever reducing) effects are equal to those of aspirin, its anti-inflammatory effects are weak. Acetaminophen is available without prescription and is relatively inexpensive.
Acetaminophen analgesic effects make it an acceptable medication in the treatment of low back pain. While effective against mild to moderate pain in some acute back pain situations, it does not offer the patient other desirable effects against inflammation, muscle spasm, nor sleep disturbance. Its efficacy as an analgesic for low back disorders associated with severe pain is more questionable.
The accepted oral dose of acetaminophen is 325 to 1000 mg every four to six hours, with a 24-hour use not to exceed 4000 mg. Analgesic effects are typically noted from 30 to 60 minutes following ingestion. Side effects of acetaminophen are rare. Nausea and rash are the most common side effects. However, high doses of acetaminophen can cause liver damage (hepatotoxicity). In adults, hepatotoxicity may result from a single dose of 10 to 15-grams.
Because most episodes of back pain have inflammation as a contributing factor, anti-inflammatory medication such as non-steroidal anti-inflammatory drugs (NSAIDs) is often an effective treatment option. NSAIDs reduce pain, swelling, and irritation and are the most likely to be effective for acute low back pain.
Although NSAIDs can work very effectively against symptoms, they often trigger gastrointestinal problems such as upset stomachs, ulcers, internal bleeding, nausea, indigestion or heartburn, constipation. Signs of stomach ulceration and intestinal bleeding typically include one or a combination of the following symptoms: abdominal pain, black tarry stools, weakness, or dizziness upon standing. Excessive use of NSAIDs can lead to kidney problems. Prolonged use of anti-inflammatory medications (greater than 3-4 weeks) in the setting of acute low back pain is generally not indicated and should be avoided. Combination therapy with more than one NSAID is to be avoided as the incidence of side effects is additive and there is little evidence of added benefit to the patient.
NSAIDs are available as over-the-counter and prescription medications. The prescription versions are generally stronger and longer acting. Drugs in this class include diclofenac (Voltaren), etodolac (Lodine), ibuprofen (Motrin), indomethacin (Indocin), ketoprofen (Orudis, Oruvail), nabumetone (Relafan), naproxen (Anaprox, Naprosyn), piroxicam (Feldene), salsalate (Disalcid), sulindac (Clinoril), and tolmetin (Tolectin).
For severe low back pain, narcotic pain medications may be prescribed. Narcotic agents are strong and potentially addictive forms of medication and should only be administered by a physician. Narcotic medications can be highly effective in treating back pain for short periods of time (less than two weeks). The need for prolonged narcotic therapy should prompt a reevaluation of the etiology of a patient's back pain.
The use of opioids in the treatment of low back pain should be limited to pain that is unresponsive to alternative medication, such as NSAIDs or when contraindications exist to the use of other analgesics. Chronic opioid treatment may be an option in selected patients who have failed all other treatments. These patients should be monitored for appropriate medication use on regular intervals.
Narcotic medications relieve pain by acting as a numbing anesthetic to the central nervous system. The strength and length of pain relief differs for each drug. Narcotics can cause related side effects such as nausea, vomiting, constipation, sedation, drowsiness, and respiratory depression. These side effects are predictable and can often be prevented.
Chronic opioid use may result in a tolerance to the drug. This means that higher doses of the drug are needed to obtain the same initial pain relieving effects. Some patients develop a cross tolerance, which means prolonged use of one opioid may cause a tolerance to develop to all opioids.
The body adapts to the presence of an opioid. Withdrawal symptoms appear when drug usage is reduced or abruptly stopped. Never alter the prescribed dosage or stop an opioid without the treating physician’s knowledge and advice. Withdrawal symptoms include a craving for the drug, restlessness, moodiness, insomnia, yawning, abdominal cramps, diarrhea and goose bumps.
Typically, muscle relaxants are prescribed early in a course of back pain, on a short-term basis, to relieve low back pain associated with muscle spasms (tension in muscles). Muscle relaxants are effective in the management of acute and chronic back pain. However, the incidence of side effects means that they must be used with caution.
Muscle relaxants don't directly work at the muscles. They work through the central nervous system (brain and spinal cord) to tell your muscles to relax. These agents have been shown in some studies to demonstrate superior analgesia to either acetaminophen or aspirin, and it remains uncertain if muscle spasm is a prerequisite to their effectiveness as analgesics.
Examples of muscle relaxants include: Carisoprodol (Soma), Cyclobenzaprine (Flexeril), Diazepam (Valium), Methocarbamol (Robaxin).
Carisoprodol (Soma) dosage is 350 mg every eight hours as needed for muscle spasm. Carisoprodol is typically prescribed on a short-term basis and may be habit-forming, especially if used in conjunction with alcohol or other drugs that act on the mind. Cyclobenzaprine (Flexeril) can be used on a longer-term basis and actually has a chemical structure related to some antidepressant medications. Usually it is prescribed as 10 mg every six hours as needed to relieve low back pain associated with muscle spasm, or it can also be prescribed as 10 mg at night as needed to help with difficulty sleeping. Cyclobenzaprine can impair mental and physical function, and may lead to urinary retention in males with large prostates.
Sedation is the most commonly reported adverse effect of muscle relaxant medications. Other side effects associated with muscle relaxants include drowsiness, headache, blurred vision, nausea and vomiting.
Evidence shows muscle relaxants effective in treating non-specific low-back pain
Antidepressants are sometimes taken in low doses to relax muscles, reduce pain and improve the sleeping patterns of people who suffer from chronic back pain. SSRIs (selective serotonin re-uptake inhibitors) are most often prescribed because they have fewer side effects than other types of antidepressants.
This type of medicine is not well-studied as a chronic pain treatment but is considered a reasonable treatment option. When prescribed for chronic pain control, anticonvulsants are used at doses low enough to avoid side effects, and the dosage is usually increased very gradually, if needed. Anticonvulsant medicine effectively treats chronic pain for some people but not others. One type of anticonvulsant may work better for you than another.
Anticonvulsant medications include: carbamazepine (Tegretol), gabapentin (Neurontin), phenytoin (Dilantin), pregabalin (Lyrica).
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