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Medications for Lower Back Pain
Reviewed By Brunilda Nazario, MD
When your lower back is achy and sore, everything you do – from reaching into a kitchen cabinet to bending over to pet the dog – can trigger an excruciating jolt of pain. At that time, it may feel as if nothing is more important than finding relief. Medications, like the ones listed in this guide, may help. But they should be used along with exercise and physical therapy for effective pain relief.
If you are considering medications to relieve your pain — especially chronic back pain — it’s also important to consider their risks and side effects. Certain drugs for low back pain may also interact with other medications you are taking. So carefully weigh your options with your doctor when choosing medication.
Over-the-Counter Pain Relievers
People with lower back pain often try over-the-counter pain relievers first.
Nonsteroidal anti-inflammatory drugs (NSAIDs) – including aspirin, naproxen (Aleve), and ibuprofen (Advil, Motrin) — are among the most commonly used pain relievers. They work about equally well to improve mild inflammation, swelling, and lower back pain. But they can have serious side effects, such as stomach bleeding and ulcers. Naproxen and ibuprofen may increase risk of heart attack or stroke in people who take them for a long time or in people with heart disease. You should see your doctor before taking NSAIDs for longer than 10 days.
Other NSAIDs are available by prescription.
Acetaminophen (Tylenol) doesn’t relieve inflammation, but it can help with pain and doesn’t raise the risk of stomach problems like NSAIDs do. However, taking more than the recommended amount of acetaminophen can cause liver damage, especially if you have underlying liver disease. So it’s important not to take more than the dose recommended on the package.
Opioid Pain Medications
Narcotic (or opioid) pain medicines such as codeine, oxycodone (Percocet, OxyContin), hydrocodone (Vicodin, Lortab), and morphine work by blocking the transmission of pain messages to the brain. These powerful pain relievers can help relieve severe lower back pain, but they are intended to be used only for a short period of time (not until all pain goes away). Narcotic drugs should only be used under a doctor’s supervision because they can cause physical dependence and addiction. Other side effects include severe drowsiness and constipation.
Muscle relaxants such as diazepam (Valium) or (cyclobenzaprine) Flexeril act on the central nervous system to relieve painful muscle strains and spasms. However, these drugs are not recommended for long-term use (more than two weeks) because they become less effective at actually relaxing muscles over time and because they can be habit-forming. Muscle relaxants also can cause side effects, including sedation and dizziness.
Combining a muscle relaxant with acetaminophen or an NSAID may provide better pain relief than either drug alone, at least short term. However, this kind of combination therapy may also increase the risk of side effects.
Some drugs usually prescribed to treat depression have also been shown to help relieve chronic lower back pain, and doctors sometimes prescribe these medications to alleviate pain. Low doses of tricyclic antidepressants such as amitriptyline (Elavil) and desipramine (Norpramin) have been studied most often for back pain. Side effects of these drugs may include drowsiness, dizziness, dry mouth, and appetite loss.
Antiepileptic drugs such as (gabapentin) Neurontin were designed to help people with seizure disorders and are used for the treatment of painful syndromes caused by shingles. They also may be effective for chronic low back pain. They appear to work by interfering with pain signals from the nerves. Potential side effects include drowsiness, dizziness, and sedation. These drugs work for some people but not others, and one anticonvulsant drug may work for you while other drugs may not.
If oral medications aren’t enough to relieve your lower back pain, your doctor may inject a steroid medication into the space around your spinal cord to bring down inflammation and provide short-term pain relief. Because they can weaken the immune system when used long term, they can increase risk of infection. And scientific studies show mixed results about whether they are effective at relieving back pain.
Other options are injections of a numbing medicine (anesthetic) to block pain or botulinum toxin A (Botox) – the same treatment used to reduce the appearance of wrinkles. Botox injections work by paralyzing muscles to stop spasms. Although it is not FDA approved for back pain, some doctors may prescribe Botox to relieve low back pain caused by muscle tension. It may take three to 10 days to start feeling better after a Botox injection, but the effects may last for three to four months. Side effects may include muscle paralysis and difficulty swallowing.
What to Do if Medication Does Not Help
If your back doesn’t feel better within about three days after you start taking medication, call your doctor. You might need to investigate other treatment options. After four to six weeks of discomfort, your doctor may order tests such as an X-ray or MRI or refer you to a specialist.
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