Health & Well Being

Common Medications Used For Back Pain

Written by Mike

Should I get medications for my pain right away or should I tough it out?

Using medications for your back pain is a personal choice that is dictated by the severity of your pain and your ability to comfortably complete your normal daily activities. If you are suffering from nerve pain, the pain may be so severe that you will request medication right away. Nonsteroidal anti-inflammatory medications and prednisone (a potent, steroidal anti-inflammatory) work to quickly decrease inflammation and pain which may allow you to feel better faster although this effect may be temporary. Other medications like muscle relaxants or opioid pain medications may also allow you to function more comfortably such as allowing you to get to work or to participate in family life without being a grouch, but it is important to recognize that they also do not “heal” your problem – but rather function as a band aid.  During a time of severe pain, there is nothing wrong with a band aid

I am having back pain, what tablets should I take?

If you’re having back pain and would like to try an oral medication you should start with a nonsteroidal anti-inflammatory medication such as ibuprofen, naproxen, or aspirin to decrease the pain. Many of my older patients try acetaminophen and some people believe it can be very, very helpful, while others see no effect at all. If you are older, you should try naproxen first as it has a lower risk of stomach problems compared to the other medications.

Is ibuprofen suitable for back pain relief?

Ibuprofen is an over-the-counter nonsteroidal anti-inflammatory medication that some people find very helpful for pain. It is important to take no more than the maximum number of tablets indicated on the bottle as ibuprofen can increase your risk of stomach irritation or ulceration as well as bleeding; so it is important to take it after meals. Some doctors will also recommend a proton pump inhibitor to protect your stomach while you take ibuprofen, but often it can cause other problems such as poor absorption of calcium which can result in osteoporosis later in life. If ibuprofen is not helpful after several days it will most likely not be helpful with continued use. If you find it helpful but it does not completely relieve your pain or if you have taken it for weeks to months without improvement, you should see your doctor.

Is naproxen (Naprosyn®) good for back pain?

I think of naproxen as the most powerful anti-inflammatory medication available over-the-counter. It is best for older patients as it has the lowest risk of stomach bleeding and stomach ulcers.

Can I take diclofenac (Voltaren®) for my back pain if I am diabetic and hypertensive?

Diclofenac (Voltaren®) is a very strong prescription strength nonsteroidal anti-inflammatory medication that is in the same class as over-the-counter nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen; since it is stronger, you have a greater risk of side effects. Severe or longstanding diabetes is always associated with kidney problems so adding a prescription nonsteroidal anti-inflammatory medication may cause further kidney problems or kidney failure in rare cases. Nonsteroidal anti-inflammatory medications have also been associated with high blood pressure. In this case I recommended that you consult with your doctor first before starting diclofenac or any other nonsteroidal anti-inflammatory medications.       

If ibuprofen and acetaminophen aren’t helping my back pain what will?

You may need to see your primary care doctor or see a back specialist to consider imaging so that you may get a more precise diagnosis. Your doctor may also suggest non-pharmaceutical options like acupuncture, massage, TENS (transcutaneous electrical nerve stimulation), physical therapy, biofeedback, cold, heat, or an inversion table.

What is better for back pain, naproxen (Aleve®), ibuprofen (Advil®), or acetaminophen (Tylenol®)?

You should see what works best for you but beware of the side effects and do not take these any of these medications for more than several weeks without consulting your doctor.

Are muscle relaxants good for relieving back pain?

Muscle relaxants can be good for relieving back pain but they are most helpful for allowing people with pain to sleep. cyclobenzaprine (Flexeril®) 10 mg at night or every six hours can be helpful but it may cause you to retain urine if you have prostate problem. carisoprodol (Soma®) 350 mg every 8 hours and diazepam (Valium®) 5 to 10 mg at night or every six hours can both be habit forming so they should not be used for a long periods of time. Unfortunately all these medications may cause sleep disruption when you discontinue taking them.

Can Tylenol #3® get rid of back pain?

Tylenol #3 is a combination medication with acetaminophen (Tylenol®) and a mild pain medication, codeine. It is thought that the combination medication can be more effective than either medication alone. Codeine is known to cause nausea and/or vomiting in many patients and is the primary reason that many of my patients discontinue it. It will most likely not get rid of your back pain but will make you feel better about it.

Can I take tramadol (Ultram®) for back pain while I’m taking sertraline (Zoloft®)?

Taking tramadol (Ultram®) with sertraline (Zoloft®) is not a good idea as you may develop a dangerous condition called serotonin syndrome. Tramadol is a weak mu opioid analgesic that is indicated for moderate to severe pain but can also be helpful for depression. Depression is thought to be due to low levels of the neurotransmitters norepinephrine and serotonin within nerve endings. Tramadol inhibits the reuptake of norepinephrine and serotonin from nerve endings increasing the neurotransmitters within the nerve endings which decreases the symptoms of depression. Sertraline is a selective serotonin reuptake inhibitor so it also inhibits the reuptake of serotonin in the nerve endings. When there is an abnormally high amount of serotonin within the nerve endings you may develop a condition called serotonin syndrome which is associated with headache, chest pain, psychosis, confusion, severe sweating, tremors, very high blood pressure, high fever, seizures or unconsciousness. Serotonin syndrome may also be caused by combining your medications with certain herbal supplements or illegal drugs.

What is the best painkiller for back pain?

There is no single best pain killer. Some people swear by certain medications and others find no medication helpful. You should think of pain medication as a tool to decrease the pain to at least allow you to function in everyday life. It is very rare to hear my patients report that their painkillers have completely relieved their pain. You should be aware that some pain medications, mostly the ones based on morphine, can cause drowsiness, decrease your usual sharp thinking or result in terrible constipation.

Can I take leftover Percocet for back pain?

Generally it is not recommended to take expired Percocet or other medications as they are often not as effective for pain control.

Why would my doctor continue prescribing Vicodin for back pain if it is so bad for me?

Vicodin as a medication is not bad for you if taken properly and for the right reason. Although it is a morphine derivative and has had negative coverage in the media recently, it can be very helpful as a pain reliever to allow you to function in your everyday life. You should be aware of the most common side effects of Vicodin are drowsiness nausea, vomiting and constipation. If you take Vicodin for a long period of time your body may get used to it, a condition called tolerance that can result in flu-like symptoms with sudden discontinuation of the medication. If it is slowly decreased then discontinued, you have a much lower risk of withdrawal symptoms. Although Vicodin can be addictive if taken for pleasure, addiction is very, very uncommon if taken to control your pain. The long term effects of Vicodin use have not been firmly established, so it is important to consider it a short term pain medication.

Is there a stronger pain medication than morphine for back pain?

Morphine has been mentioned in literature going back thousands of years ago so it remains the quintessential pain medication that all other pain medications are measured against. Medications that are stronger than morphine include methadone and dilaudid (10 times stronger than morphine) and fentanyl (100 times stronger than morphine). Even though these medications are so much stronger than morphine they still may not be 100% effective in treating your back pain but they can help a great deal if used properly.

What do doctors think is the top pain medication for back pain?

The top pain medication prescribed by doctors is hydrocodone (Vicodin®); this is probably due to drug regulatory laws rather than for its effectiveness. Unfortunately identifying the top pain medication for back pain is a process of trial and error with a goal not only for effectiveness but also with the fewest number of reported side effects. This approach is best described in the World Health Organization Pain Ladder approach that was first published about 30 years ago and has guided pain management ever since. I start with a simple nonsteroidal anti-inflammatory medication that is either over-the-counter or prescription strength and if this is not helpful then I proceed to prednisone which is a corticosteroid, if I think that inflammation is the underlying cause of pain, or a muscle relaxant. If this is still not effective than I will try a weak opioid pain medications such as Tramadol (Ultram®), oxycodone (Percocet®), hydrocodone (Vicodin®) and add adjuvant pain medications such as antidepressants sertraline (Zoloft®) or duloxetine (Cymbalta®) and/or anti nerve agents such as pregabalin (Lyrica®), neurontin (gabapentin®), topiramate (Topamax®). If there is still no significant effect, I will try a stronger opioid medications such as morphine (Avinza®), hydromorphone (dilaudid®), methadone or Fentanyl (Duragesic®).

Conclusion

Back pain that makes a sudden and horrific appearance can be very frightening as it comes out of nowhere and can render you helpless. Knowing what to do and why is paramount. I hope you found great ideas to heal your back pain fast.

About the author

Mike

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