Back pain is one of the most common reasons that people visit their doctors. In fact, around 80% of adults experience low back pain at some point in their lives. For many, the pain is acute and goes away after a few days or weeks. But for others, it becomes a chronic issue that impacts their quality of life.
If you’re dealing with back pain, whether acute or chronic, you may be eager to find some relief. The best medication for back pain depends on your specific circumstances. In this article, we’ll explore some of the top medication options for managing back pain, including over-the-counter meds and prescription drugs. We’ll look at how they work, the potential benefits of each, as well as the possible side effects and risks.
Over-the-Counter Pain Relievers
For mild or acute back pain, over-the-counter (OTC) medications are usually the first line of defense. Two main types are typically used:
Acetaminophen (Tylenol)
Acetaminophen, the active ingredient in Tylenol, is often doctors’ top choice for OTC back pain relief. Here’s a quick rundown:
- How it works: Stops pain signals from reaching the brain
- Benefits: Gentler on stomach than other OTC meds
- Risks: Liver damage if excess doses taken
Doctors recommend limiting intake to 3,000 mg per day maximum. For most people, acetaminophen brings moderate pain relief without some of the digestive issues caused by other meds. However, it doesn’t reduce inflammation in the body.
NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) are another go-to OTC option. Common examples include:
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve)
- Celecoxib (Celebrex)
NSAIDs reduce pain and inflammation. They can be more effective than acetaminophen alone for some people’s back pain. However, they also come with higher risks:
- How they work: Block pain signals and reduce swelling
- Benefits: Fight inflammation causing back pain
- Risks: Digestive problems, ulcers, bleeding, kidney issues
Doctors urge caution with long-term NSAID use. But short-term, around one week or less, they are usually considered safe for most people.
Prescription Medications
If OTC meds aren’t getting the job done, several prescription medications may provide relief for chronic or severe back pain. They include:
Muscle Relaxants
Muscle relaxants ease painful muscle spasms associated with some types of back pain. They include:
- Cyclobenzaprine (Flexeril)
- Carisoprodol
- Methocarbamol
Despite the name, these drugs don’t directly relax muscles. How they work: Act on the central nervous system to reduce pain signals.
In the short term, they can effectively reduce back spasms when combined with an NSAID. Benefits include reduced cramping, improved mobility.
Risks involve the central side effects: sleepiness, confusion, dizziness, etc. These drugs also have a dependence risk with long-term use.
Opioids
Prescription opioids bind to receptors in the body to block pain signals. Common examples are:
- Codeine
- Oxycodone (OxyContin)
- Hydrocodone (Vicodin)
For severe short-term pain, opioids can provide relief when other medications haven’t worked. However, doctors now recognize the substantial risks – including dependence, addiction, accidental overdose and organ damage:
- How they work: Bind to opioid receptors, blocking pain signals
- Benefits: Can provide short-term relief for severe pain
- Risks: Dependence, organ damage, accidental overdose
Strict precautions around use must be taken.
Antidepressants
Certain types of antidepressants, in small daily doses, may relieve chronic back pain – even in people not depressed. Examples:
- Amitriptyline
- Nortriptyline (Pamelor)
- Duloxetine (Cymbalta)
It takes several weeks to experience pain relief from these drugs. How they work: Change brain chemicals to alter pain perception.
Benefits include improved sleep, which gives the body a break from pain. Risks can include fatigue, dry mouth, blurred vision and mood changes.
Anti-Seizure Medications
Lastly, anti-seizure drugs that impact nerve signaling may help with radiating or nerve-related back pain:
- Pregabalin (Lyrica)
- Gabapentin (Neurontin)
How they work: Calm excessive nerve signals causing pain.
These meds could benefit those with sciatica or disc-related back pain. Benefits are pain relief, improved daily function. Risks range from drowsiness, dizziness to loss of coordination.
While prescription meds play a role for some, they aren’t the only pain management options. Lifestyle changes like weight loss, physical therapy, massage, heat/ice therapy and stress relief are key for ongoing comfort. If back pain persists, seeing a pain management specialist is wise. Stay hopeful – with some patience and the right treatment plan, relief may be around the corner!
Written by Dr. Tony Mork
Orthopedic Spine Surgeon
I’m Dr. Tony Mork, MD, a Minimally Invasive Orthopedic Spine Surgery Specialist in Newport Beach, California. With over 40 years of experience, I’m dedicated to providing information for all topics that involve neck and back pain.
January 19, 2024
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