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Medications for back pain

Information

Your back pain may not go away completely, or it may get more painful at times. Learning to take care of your back at home and how to prevent repeat episodes of back pain may help you avoid surgery.

Different medications can also help with your back pain.

Over-the-counter pain relievers

Over-the-counter pain relievers can help with your back pain. Over-the-counter means you can buy them without a prescription.

Most doctors recommend acetaminophen (such as Tylenol) first because it has fewer side effects than other drugs. Do not take more than 3 grams (3,000 mg) on any one day or 24 hours. Overdosing on acetaminophen can cause severe damage to your liver. If you already have liver disease, ask your doctor if acetaminophen is OK for you to take.

If your pain continues, your doctor may suggest nonsteroidal anti-inflammatory drugs (NSAIDs). You can buy some NSAIDs, such as ibuprofen and naproxen, without a prescription. NSAIDs help reduce the swelling around the swollen disc or arthritis in the back.

NSAIDs and acetaminophen in high doses, or when taken for a long time, can cause serious side effects. Side effects may include stomach pain, ulcers or bleeding, and liver or kidney damage. If side effects occur, stop taking the medicine right away and tell your health care provider.

If you are taking pain relievers for more than a week, tell your doctor. You may need to be watched for side effects.

Narcotic pain relievers

Narcotics, also called opioid pain relievers, are used only for pain that is severe and is not helped by other types of painkillers. They work well for short-term relief. Do not use them for more than 3 to 4 weeks. These medicines are only rarely used to treat someone with chronic pain.

Narcotics work by binding to receptors in the brain, which blocks the feeling of pain. These drugs can be abused and are addictive. They have been associated with accidental overdose and death. When used carefully and under a doctor's direct care, they can be effective in reducing pain.

Examples of narcotics include:

  • Codeine
  • Fentanyl (Duragesic) -- available as a patch
  • Hydrocodone (Vicodin)
  • Hydromorphone (Dilaudid)
  • Morphine (MS Contin)
  • Oxycodone (Oxycontin, Percocet, Percodan)
  • Tramadol (Ultram)

Possible side effects of these drugs include:

  • Drowsiness
  • Impaired judgment
  • Nausea or vomiting
  • Constipation
  • Itching

When taking narcotics, do not drink alcohol, drive, or operate heavy machinery.

Muscle relaxants

Your doctor may prescribe a medicine called a muscle relaxant. Despite its name, it does not work directly on muscles. Instead, it works through your brain and spinal cord.

This medicine is often given along with over-the-counter pain relievers to relieve the symptoms of back pain or muscle spasm.

Examples of muscle relaxants include:

  • Carisoprodol (Soma) -- may be more addictive than others
  • Cyclobenzaprine (Flexeril)
  • Diazepam (Valium)
  • Methocarbamol (Robaxin)

Side effects of muscle relaxants are common and include drowsiness, confusion, nausea, and vomiting.

These medicines can be addictive. Talk to your doctor before using these drugs, as they may interact with other medicines or make certain medical conditions worse.

Do not drive or operate heavy machinery while taking muscle relaxants. Do not drink alcohol while taking these medications.

Antidepressants

Antidepressants are normally used to treat people with depression . However, low doses of these medicines can help with chronic low back pain , even if the person does not feel sad or depressed.

Antidepressant medicines work by changing the levels of certain chemicals in your brain. This changes the way your brain notices pain. Antidepressants most commonly used for chronic low back pain also help you sleep.

Antidepressants most often used for back pain are:

  • Amitriptyline (Elavil, Endep)
  • Desipramine (Norpramin)
  • Duloxetine (Cymbalta)
  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor, Aventyl)

Common side effects of these medicines include dry mouth, constipation, blurred vision, weight gain, sleepiness, problems urinating, and sexual problems. Less commonly, some of these drugs can also cause heart and lung problems.

Do not take these drugs unless you are under the care of a doctor. Do not stop taking these drugs suddenly or change the dose without also talking with your doctor.

Anti-seizure or anticonvulsant medicines

Anticonvulsant medicines are used to treat people with seizures or epilepsy . They work by causing changes in the electric signals in the brain. They work best for pain that is caused by nerve damage.

These drugs may help some patients whose long-term back pain has made it hard for them to work, or that interferes with their daily activities.

Anticonvulsants most often used to treat chronic pain are:

  • Carbamazepine (Tegretol)
  • Gabapentin (Neurontin)
  • Lamotrigine (Lamictal)
  • Pregabalin (Lyrica)
  • Valproic acid (Depakene)

All of these drugs have their own side effects. Common side effects include weight gain or weight loss, upset stomach, loss of appetite, skin rashes, drowsiness or feeling confused, and headaches.

Do not take these drugs unless you are under a doctor's care. Do not stop taking these drugs suddenly or change the dose without also talking with your doctor.

References

Barbano RL. Mechanical and other lesions of the spine, nerve roots, and spinal cord. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 407.

Chou R, Qaseem A, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.

Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34:1078-93.

Cohen SP, Raja SN. Pain. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 29.

Updated: 5/13/2013

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.


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