Have back pain? Medications can help.
Walking upright is what made humans humans. But it also made us susceptible to perhaps the most common affliction among our species: back pain. Harvard Health says that an estimated 80% of people will seek medical attention for back pain at some point in their lives.
Back pain can come from aging and weakened muscles in the body’s core, diseases like osteoarthritis, injuries and even depression.
For most, over-the-counter pain relievers are enough to calm the pain. For others, more potent medications may be called for. Remember, drugs only mask the pain; they don’t solve the problem behind the pain. If short-term medications don’t do the trick, talk to a doctor, who can diagnose and treat the underlying condition as well as prescribe other treatments, including medication.
There is a wide range of medications used to treat back pain. “Physicians base treatment on why you are having the pain, exactly where it is and what symptoms you are having,” says Dr. Margot Savoy, a practicing family physician in Philadelphia and a member of the American Academy of Family Physicians Board of Directors. She is also associate professor and chair of the Department of Family and Community Medicine at the Lewis Katz School of Medicine at Temple University and chief quality officer for Temple Faculty Physicians in Philadelphia.
For some types of pain, such as a muscle strain, over-the-counter nonsteroidal anti-inflammatory drugs, or NSAIDs, are all that are needed. Acetaminophen, which is an analgesic (pain reliever) and antipyretic (fever reducer), may be used alone or in combination with an NSAID as well, “along with some home stretching and maybe heat or ice,” Savoy says.
If the pain is very severe, or is also causing nerve irritation, stronger prescription medications can be used. These include higher-dose NSAIDs, muscle relaxers, antidepressants, seizure medications or opioids.
Here is a closer look at the drug types most often used to treat back pain.
NSAIDs and acetaminophen
NSAIDs are the first choice for most mild to moderate cases of back pain. They reduce pain, swelling and inflammation in the muscles and other soft tissues that surround the spine.
These are available both over-the-counter and in higher-dose prescription form. Common over the counter choices include:
— Aspirin (Bayer, Bufferin).
— Ibuprofen (Advil, Motrin).
— Naproxen (Aleve, Naprosyn).
— Celecoxib (Celebrex).
Acetaminophen (Tylenol) is a different type of pain reliever that is found in the pharmacy aisles along with NSAIDs, but it doesn’t reduce inflammation. It does relieve pain, though, and is a good adjunct therapy when an NSAID isn’t enough.
Most people can safely take a few doses of either ibuprofen or acetaminophen over several days, as long as they are taken per the label directions, says Dr. Jennifer Brull, a practicing family physician in Plainville, Kansas, and a member of the American Academy of Family Physicians Board of Directors. She is also regional medical director for five accountable care organizations of independent primary care practices in Kansas, Oklahoma, Missouri, Colorado and Utah. “People who have significant kidney disease should consult with their doctor before taking ibuprofen, and people with liver disease should be cautious about taking acetaminophen,” she warns.
Muscle relaxants are available by prescription. They interact with the central nervous system to block pain, especially when it is accompanied by muscle spasms.
“A muscle relaxant may help the muscles not clench up tightly, which will relieve pain from pressure on nearby nerves,” Brull says.
Common muscle relaxants include:
— Carisoprodol (Soma).
— Chlorzoxazone (Parafon Forte).
— Cyclobenzaprine (Flexeril).
— Methocarbamol (Robaxin).
— Orphenadrine (Norflex).
These medications are likely to make you drowsy, so take them carefully and under a doctor’s supervision. “If you are prescribed a muscle relaxant, you should be careful about drinking alcohol as both can cause sedation,” Brull says.
Doctors may prescribe some classes of antidepressants to help manage pain, including chronic lower back pain, even when the patient is not diagnosed with depression.
It’s not clear how they work to relieve pain. But antidepressants are not addictive and are usually well tolerated, with few, if any, side effects. Speak with your doctor about whether this may be an option.
The Mayo Clinic says that the most common antidepressants used for pain include:
— Selective serotonin reuptake inhibitors, or SSRIs.
— Serotonin and norepinephrine reuptake inhibitors, or SNRIs.
The antidepressant duloxetine (Cymbalta), a SNRI, is one of the most effective for treating pain, according to Harvard Health Publishing.
More severe and chronic back pain may be treated with an opioid. These strong prescription drugs block receptors on nerve cells in the body that produce pain.
Opioids are controlled substances, with a high risk of addiction and are considered the last resort when other treatments have failed. However, they are usually safe when taken under the close supervision of a doctor for short-term relief.
Some common opioids include:
— Oxycodone (Oxycontin).
— Oxycodone and acetaminophen (Percocet).
— Oxycodone and aspirin (Percodan).
— Hydrocodone and acetaminophen (Vicodin).
Antiseizure medications, also known as anticonvulsants, have been used to treat nerve pain for many years, according to the Mayo Clinic. They work by slowing and calming nerve signals and are most often used for neuropathy — caused by diabetes, shingles and some other conditions — neuralgia and fibromyalgia.
Antiseizure drugs include:
— Carbamazepine (Carbatrol, Tegretol).
— Oxcarbazepine (Trileptal, Oxtellar XR).
— Lamotrigine (Lamictal).
— Phenytoin (Dilantin).
— Valproic acid (Depakene).
— Gabapentin (Gralise, Neurontin, Horizant).
Pain relief without medication
“My favorite ‘medicine’ for back pain is stretching and physical activity; lying in bed or a chair when your back hurts can often lead to it hurting more,” Brull says. “Most acute back pain resolves within several days, just by letting your body rest and heal naturally.”
Savoy agrees: “Most of us won’t need to take medications for our back pain. Gentle stretches and supportive care like heat and ice will be enough to allow us to heal.”
And, Savoy adds, “Physical therapy is underrated. Often, once we hurt our back, we adopt bad posture and habits. Physical therapy can help strengthen our core muscles and not only help the current pain feel better but prevent future episodes of back pain.”
When to see a doctor
If you ever have severe pain that lasts more than a brief period of time — a few days to a week or two — and is not controlled with stretching, rest, ice and OTC meds, you should see your doctor. “If you lose the ability to walk due to back pain, have weakness in your feet or legs, feel numbness or tingling in your feet or legs or lose control of your bladder or bowel, you need to be seen urgently,” Brull says.
You should also see your family physician “if you are experiencing new back pain when you don’t know how it happened, or back pain after a fall or injury like a car accident,” Savoy adds.
Top medications for treating back pain
— NSAIDs and acetaminophen
— Muscle relaxants
— Antiseizure drugs
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