About one in 4 Americans has experienced low back pain within the previous three months, making it among the most typical types of pain and the most regular reason for special needs in adults under 45.
Although pain medication cannot really recover a back injury, it can ease pain and open a window for other treatments — such as physical therapy — to have a chance to work.
There are multiple classifications and types of medications for back pain; depending upon how severe your symptoms are, the length of time you’ve had them, where they’re located, and what side effects you can endure.
What Is a Good Painkiller for Back Pain
Anti-Inflammatory Medications
The first medication of choice for many people with back pain is an over-the-counter, nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Motrin) or naproxen (Aleve), says Jae Jung, MD, assistant teacher in the department of orthopaedics at the David Geffen School of Medicine at the University of California-Los Angeles. “These are considered milder analgesics, and would be the first tier of treatment,” he states.
Tylenol (acetaminophen), while not a nonsteroidal anti-inflammatory drug, is also a typical over-the-counter painkiller used to treat back pain.
There are likewise prescription-only NSAIDs, such as celecoxib (Celebrex), diclofenac (Voltaren), meloxicam (Mobic), and nabumetone (Relafen).
Although these medications are on the milder side of the pain relief spectrum, they still come with side effects — especially if you take them at greater dosages for a long period of time. NSAID side effects can include intestinal problems, ulcers, and kidney damage, while acetaminophen can impact the liver.
Jung says he’s had patients inform him they’ve been taking 6 to 8 ibuprofen daily for 6 months. “That can be an issue,” he states. “In the pain world, anything more than three months is chronic pain. So, if you’ve been taking an NSAID or acetaminophen to manage back pain for 3 months or more, you must see a doctor to a minimum of find out if you’re taking the right medication at the right dose.”
You can likewise get your anti-inflammatory medication in the form of a topical cream that can be used directly to the back. While these technically have the potential for the very same side effects as the oral medications, the risk is not the very same, because they’re not impacting your entire body, says Jung.
Other topical treatments that can be used for pain consist of ingredients such as capsaicin, camphor, menthol, and eucalyptus oil.
Muscle Relaxants
If over-the-counter painkiller or prescription NSAIDs are not relieving your back pain, your doctor might recommend including a muscle relaxant. These medications include:
- Cyclobenzaprine (Flexeril)
- Tizanidine (Zanaflex)
- Baclofen (Lioresal)
- Carisoprodol (Soma)
There are numerous trademark name in the same classification, states Jung. They help relieve the muscle convulsions that are triggering your back pain.
Muscle relaxants might be especially useful for severe injuries (such as straining your back playing basketball), states Jung. For instance, carisoprodol (Soma) considerably reduced back pain and enhanced function after three days of treatment, according to the results of clinical trials presented at the American Academy of Pain Medicine’s 2010 annual conference.
Most of these drugs have comparable side effects, with drowsiness being the most common. “They can be rather sedating,” Jung states. “If you’ve never ever tried them in the past, do not run heavy equipment or drive till you know how they impact you. I typically start patients on these during the night to see how they respond.”
Opioids
For some patients, NSAIDs and muscle relaxants are not enough. Individuals with long-lasting, chronic back pain, particularly after several surgical treatments, are sometimes recommended opioid or narcotic medications. In fact, one research study revealed that as lots of as 70% of back pain patients get opioids, which some specialists recommend is probably too many.
These drugs act on pain receptors in the brain and nerve cells to ease pain. Jung says there are milder, shorter-acting variations, such as Vicodin (acetaminophen and hydrocodone) and Tylenol with codeine — which is what many people begin with — along with stronger drugs like morphine.
Their most common side effects include:
- Drowsiness and sedation
- Constipation
- Risk of dependence
- Allergic reactions, such as hives and itching
There’s also an action between NSAIDs and muscle relaxants and a more traditional opioid or narcotic drugs. Tramadol (brand names Rybix, Ryzolt or Ultram) also acts upon the opioid receptors in the brain, however it is weaker compared to morphine or hydrocodone, so it’s not controlled like an illegal drug, says Jung. “So it’s a milder method and patients who do not wish to carry on to narcotics often think that’s an excellent alternative,” he states.
In many cases, however, narcotics can be needed. “I’ve seen patients who’ve had several back surgical treatments and have actually been on morphine for 10 years, which’s the only method they can mange their pain,” Jung states.
However caution is required. In fact, long-lasting opioid use may make back pain worse. “There’s information coming out now that being on these medications for long periods, at high adequate doses, can change the nervous system so that you in fact perceive pain more. I attempt not to encourage chronic use, although some people just can’t come off those medications enough to function.”
Corticosteroids
Like anti-inflammatory drugs, corticosteroids can likewise relieve swelling and minimize back pain. They can be taken either orally or through injection into your back.
“Steroids are the most powerful anti-inflammatory that we have in our arsenal,” says Jung. A brief course of oral steroids may even be attempted before opioids when someone has actually had serious back pain for a couple of weeks, without relief from NSAIDs and muscle relaxants. This might calm inflammation down before it becomes chronic.
To achieve this objective, Jung says, he frequently prescribes a dosage pack of Medrol (methylprednisolone). A patient takes 24 mg the first day, then decreases the dosage by 4 mg every day for an overall of five or 6 days. “This can short-circuit the pain cycle,” says Jung.
Corticosteroid medication can likewise be injected into the space around the nerve roots of the spine or into the facet joints, which are spinal joints that can develop arthritis. “This delivers an effective medication straight to the source of the pain, as in your area as possible, and lessens the side effects of taking a systemic tablet,” Jung says.
How safe are steroid injections? “The agreement in the medical neighborhood is that it’s safe to obtain about 3 injections per year,” Jung says. Side effects of extreme steroid use consist of bone loss, weight gain, and damage to the body’s ability to procedure blood glucose. “I’ll see patients who will tell me they’ve done an injection every other month. That’s too much, in my viewpoint.”
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Adjuvant Therapies
Why would you take an antidepressant or an anti-seizure drug for your back pain? Due to the fact that they can be really effective for a particular kind of pain — the kind caused by nerve issues.
“Certain antidepressants, like Cymbalta [duloxetine], and anti-seizure medications, like Lyrica [pregabalin] or Neurontin [gabapentin] have been shown to be beneficial for nerve symptoms,” describes Jung. Another class of antidepressants, called tricyclics — consisting of amitriptyline (Elavil) and nortriptyline (Pamelor) — likewise might be recommended to manage chronic back pain. “So if you have a pinched nerve in the back, with pain that radiates down your leg, one of these medications can be extremely effective to quiet the nerve irritation and alleviate the burning pain, numbness and tingling that are typically involved.”
Although they differ somewhat, the antidepressants and anti-seizure medications used to treat back pain have a relatively comparable lists of side effects. The more common side effects of these medications include:
- Headaches
- Queasiness
- Constipation
- Diarrhea
- Insomnia
- Sexual side effects
- Tiredness
Call your doctor if you experience any of these more major side effects:
- Allergic reactions such as hives, itching, and swelling
- Modifications in heart rhythm
- Seizures
- Confusion or hallucinations
- Failure to sit still
- Aggression, state of mind swings, or other considerable behavior changes
- Thoughts of suicide
No matter which medications you consider your back pain, Jung says that they must not be your only mode of relief.
“If a patient has just had pain for a few days, I do not want to blast them with chemicals — they might just recuperate by themselves. With pain that’s lasted three months or more, we try to use more than one medication to relieve their pain,” he states. “We have to get patients involved in their care. Physical therapy should be used at an early stage. Teaching the patient to exercise, in combination with your other therapies, is a lot much better than simply providing tablets to take.”
