(ĐTĐ) – 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 sodium (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. Although NSAIDs are reasonably safe medications, it is important that you are aware of potential side effects. NSAIDs are safest when low doses are taken for brief periods. Side effects most commonly occur if you are taking large doses over a prolonged time (months or years) and can include stomach pain, bleeding, and stomach ulcers.
Naproxen and ibuprofen and certain other prescription NSAIDs may increase the 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.
Acetaminophen (Actamin, Panadol, Tylenol) is not an NSAID, 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. If you have liver disease, check with your doctor before taking acetaminophen.
Opioid Pain Medications
Narcotic (or opioid) pain medicines such as codeine, oxycodone, hydrocodone, and morphine work by blocking the transmission of pain messages to the brain. 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 (Amrix, Fexmid, Flexeril) act on the central nervous system to relieve painful muscle strains and spasms. However, these drugs can be habit-forming. Muscle relaxants also can cause side effects, including sedation and dizziness.
Some drugs typically prescribed to treat depression have also been shown to help relieve chronic lower back pain, and doctors sometimes prescribe these medications to alleviate pain. Duloxetine (Cymbalta) is approved for chronic musculoskeletal pain including pain from osteoarthritis and chronic low back pain. Low doses of tricyclic antidepressants such as amitriptyline (Elavil, Endep, Vanatrip) and desipramine (Norpramin) are often used to treat low back pain. Side effects of these drugs may include drowsiness, dizziness, dry mouth, and appetite loss.
Antiepileptic drugs such as Fanatrex, Gabarone, Gralise, Horizant, Neurontin (gabapentin) or Lyrica (pregabalin) were designed to help people with seizure disorders and are often used for the treatment of painful syndromes caused by the virus that causes 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. 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.