Back pain hurts. Sometimes it feels like a muscle ache, while other times it is experienced as a severe, shooting, or stabbing sensation. It may radiate down to the legs, and get worse when lifting, twisting or simply walking.
The back pain often improves with home treatment and self-care in a few weeks. But what can you do when the pain is acute and severe? Let’s explore in this article the back pain medication.
Back pain medication
- The first line therapy for most people with low back pain are non steroid antiinflammatory drugs (NSAIDs). Over the counter NSAIDs include acetaminophen, ibuprofen and naproxen. These drugs help relieve pain and reduce inflammation. Prescription NSAIDs include celecoxib, diclofenac, meloxicam, and nabumetone. These drugs should be used as recommended. Taking higher doses or for too long increases the chances of side effects , particularly ulcers and other digestive problems, kidney or liver damage. Another way to minimize the risk of side effects is to use the NSAIDs in cream and ointment form, applied locally, rather than taking them in oral form.
- Muscle relaxants work by relieving muscle spasms, although their benefits for back pain are controversial. Carisoprodol, metaxalone, cyclobenzaprine, diazepam,or methocarbamol are all muscle relaxants. They should be used short term – for up to 72 hours, best to be taken at bedtime. Elderly should avoid muscle relaxants due to increased risk of confusion and drowsiness.
- Opioid and narcotic medication. If NSAIDs don’t provide enough relief, stronger analgesic can be prescribed for short term only. Among these drugs, the acetaminophen and hydrocodone combination or acetaminophen with codeine combination are the most commonly used. Morphine is stronger, and used in selected cases. It is important to keep the treatment as short as possible, as long term use of opioid painkillers increase sensitivity to pain, have many adverse reactions (i.e. drowsiness, sensation,constipation, allergic reactions) and there is also risk of dependency and abuse.
- Tramadol can be a good choice for an individual who needs stronger medication than NSAIDs or muscle relaxants, but weaker than hydrocodone or morphine. Tramadol can also cause side effects including constipation, drowsiness, fatigue, dry mouth and skin rashes.
- Corticosteroids are sometimes recommended- either in oral form or injections. A combination of corticosteroids (like dexamethasone or methylprednisolone) and the anesthetic lidocaine can be injected in the epidural space in case of chronic back pain. These injections are more effective for sciatica due to herniated disk than back pain caused by spinal stenosis. They may be recommended in case of chronic back pain, which is defined as back pain that lasts more than 3 months. These injections provide pain relief for limited time- up to a few weeks, enough to help people feel better and start a physio exercise program. Injections are typically recommended about three times a year. Corticosteroids have strong painkiller and antiinflammatory effects and could be used for severe back pain that does not respond to NSAIDs and muscle relaxants, before trying opioid or narcotic painkillers. Oral corticosteroids are prescribed short term- for example for a 5-6 days period, with higher doses in the first day, than gradually use lower doses. It is best to avoid long term use of corticosteroids- which is associated with osteoporosis, weight gain and blood sugar imbalances.
What is the best medication for back pain?
Doctors look at both the benefits and risks of medication when recommending a certain treatment plan. For this reason, the first line of drugs is NSAIDs (over-the-counter or prescription NSAIDs), not corticosteroids and opioid or narcotic drugs- which are more effective but also carry more risks. Fortunately, many people experience relief from regular NSAIDs and do not need stronger drugs.
What is the best medication for back pain based on feedback from patients? An online survey from Drugs.com shows that the NSAID diclofenac (and the brands Voltaren, Cataflam) has some of the highest ratings ( between 7.8-9 out of 10). The prescription drugs acetaminophen/hydrocodone and tramadol received the most reviews, but lower ratings – 6/10 and 6.4/10 respectively. Over-the-counter NSAIDs like ibuprofen and acetaminophen (various brands) were rated with an efficacy between 6 and 9/10.
In the end, different people will react differently to the same medication. For example, diclofenac may provide the most relief in some individuals, while others will do best on acetaminophen. Sometimes a few drugs may be tried before finding the one that works best for an individual. If the condition changes and the pain is getting worse, another drug can be recommended. Genetics play a role, too. For example, some people have genetic mutations and do not respond at all to morphine, despite getting higher doses than average. In the future, these painkillers will be recommended based on genetic tests. A genetic test like Homecare for example can suggest the best pain relief medication, including how effective it may be, how the drug is metabolized, the potential risk for toxicity, and side effects.
Back pain medication is only one component of treating the pain effectively. A good treatment plan also involves home care like rest for a few days followed by an exercise program, heat and cold applications, and therapies like massage. In some cases, surgery will be required.
