Back Pain Medications
ANALGESICS & NSAIDS
Back pain affects the majority of people at some point in their lives. Many people will take some form of medication to treat the condition. Over the counter remedies that are commonly suggested to treat back pain include analgesics such as acetaminophen (Asprin) and certain NSAIDs (non-steroidal anti-inflammatory drugs) such as Naproxen Sodium (Aleve) and Ibuprofren (Advil). These medications work differently and may be taken at the same time. Occasionally, you may be able to apply a special spray or cream to the area such as Ben-Gay, Icy Hot or Capsaicin (Zostrix) that can be helpful. In addition, topical analgesics, which contain salicylates, a major component in aspirin, might provide relief.
However, there are certain NSAIDs which are stronger and need a prescription to be used such as Celebrex. These are considered COX-2 inhibitors. Side effects can be problematic and include: gastrointestinal bleeding, hypertension, fluid retention, liver problems and an increased risk of strok and/or heart attack.
NARCOTICS & OPIOIDS
The most widely prescribed medications are still the narcoids, aka opioid analgesics. These act on the brain relay system that processes pain. Generally not used as a long-term treatment, these medications have some serious side effects and a patient can be dependent upon or addicted to them. Side effects include nausea, constipation, dizziness and sedation. The most commonly prescribed narcotic/opioids are:
- morphine (MS Contin, Oramorph SR, Avinza etc.),
- oxycodone (OxyContin, Percoset, Roxicodone, Oxy IR),
- methadone (Dolophine HCL, methadose),
- fentanyl (Duragesic or Actique),
- levorphanol (Levo-Dromoran),
- and codeine (Tylenol #3).
Generally speaking, muscle relaxants are prescribed early on in the course of the back pain and on a short-term basis. They are geared towards relieving lower back pain associated with muscle spasms. Several types of muscle relaxant medications are generally used to treat low back pain difficulties such as:
- Soma (Carisoprodol)
- Flexeril (Cyclobenzaprine)
- and Diazepam (Valium)*
* It should be noted that Diazepam is also a depressant and can worsen depression that can often accompany chronic pain. Diazepam has been known to affect sleep cycles so it should not be used long-term.
Because back pain can be intense, neuropathic medications are often prescribed to patients to help them cope. Resulting from injuries to the nervous system, neuropathic pain can go deep into the tissue and be treated in a variety of ways with medications that are not normally considered ‘pain relievers.’ However, these medications can help the body reprogram messages involved in sending pain signals to the brain. The three most commonly prescribed neuropathics are:
1) Antidepressants, or Tricyclic Antidepressants (TCAs) like Amitriptyline, Elavil and Nortriptiline. In some cases, newer medications such as Selective Serotonin Reuptake Inhibitors can be prescribed such as Paxil, Zoloft and Lexapo but they don’t seem to work as well in controlling the back pain specifically.
2) Anticonvulsant medications (aka neuroleptics) can help reduce or prevent abnormal increases in brain activity with fewer side effects than the tricyclics. These medications include:
- Topamax (topiramate),
- Dilantin (phenytoin),
- Neurontin (gabapentin),
- Tegretol (carbamazepine),
- and Lyrica (pregabalin).
3) Local anesthetics, or nerve blockers, can be injected into the nerve itself to help keep the individual from feeling pain especially if it’s too intense. When the nerve pain comes from an irritated nerve outside the spinal cord, there are two ways to block the pain. The doctor can block the nerve with local anesthetics or directly block the substances P and glutamate in the primary neuron. Local anesthetics include substances such as novocaine, lidocaine, bupivacaine, ropivacaine or chirocaine. The primary neuron blocks include the aforementioned Capsaicin, Glutamate, glycine or even gabapentin (Neurontin).
Potent anti-inflammatory hormones, steroids are medications that can be useful in easing pain and acute flare-ups. Examples of these medications include Prednisone (prednisolone), Dexamethasone (Decadron) and methylprednislone (Medrol). Steroids should be used with extreme caution especially if used longer than a week. They can also suppress the body’s output of normal cortisone through the adrenal glands, inhibiting the effectiveness of white blood cells. This makes it harder for the body to ward off infection. Steroids can also cause weight gain, fluid retention and swelling as well as increased appetite.
BOTULINUM TOXIN A & B
Botulinum Toxin (Botox) can be effective in helping treat muscle spasms. This type of treatment has been improved by the US Food & Drug Administration. Botulinum Toxin A is injected into the affected area and takes about three to ten days before the patient feels relief. However, the effects of the medication can last for several months. Side effects can be problematic and can include excessive paralysis and difficulty swallowing.
Some patients will develop a tolerance to Botulinum Toxin A. At that point, the patient will be able to use Botulinum Toxin B, which is also FDA approved. Working in much the same way, Botox B has been shown to be potentially beneficial for pain management related to:
- muscle stiffness
- chronic lower back pain
- movement disorders
- and muscle spasticity related to Multiple Sclerosis and Stroke, etc.