BACK PAIN MEDICATIONS

 

Questions and Answers

Medicine Prescribed for Back Pain Includes

• aspirin
• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
• COX-2 Inhibitors
• non-narcotic prescription pain medicine
• narcotic pain medicine
• muscle relaxants
• anti-depressants

Safe Use of Over-the-Counter Medications

When it comes to common over-the-counter medications like acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve), it’s essential to follow dosing instructions carefully:

• Acetaminophen: Do not take more than 3 grams (3,000 mg) in any 24 hours. Taking too much acetaminophen can cause severe liver damage. If you already have liver disease, consult your provider before use.
• NSAIDs: These include ibuprofen and naproxen, which can be purchased without a prescription. While effective for pain and inflammation, high doses or prolonged use can lead to stomach pain, ulcers, bleeding, and potential kidney or liver damage. If side effects occur, stop taking the medicine right away and notify your provider.

Always keep your healthcare provider informed, especially if you find yourself needing pain relievers for more than a week.

Aspirin

Aspirin compounds are over-the-counter medications that can help relieve minor pain and backache. With excessive amounts of aspirin, people can develop stomach problems—namely, ulcers with or without bleeding.

However, it’s important to note the potential side effects more thoroughly:

• Stomach Problems: The primary side effect of aspirin is the development of stomach issues, particularly ulcers. These ulcers may occur with or without bleeding, posing a serious health risk.
• Pregnancy Warning: If you are pregnant, it’s crucial to avoid taking aspirin. In fact, you should not take any medication unless you have discussed it with your obstetrician.

Before taking any medication, including over-the-counter drugs like aspirin, pregnant women should always consult their healthcare provider. Safer alternatives may be available that better protect both the mother and the baby during pregnancy. By avoiding aspirin and discussing any medication use with an obstetrician, pregnant women can help ensure a healthier pregnancy and reduce the risk of unwanted complications.

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) include over-the-counter pain relievers. At one time, these medications were only available by prescription. Today, these drugs are very effective in relieving the pain associated with muscle strain and inflammation. On the other hand, the public should be aware that NSAIDs can decrease renal function in older patients. Hence, excessive use can lead to kidney problems.

It’s also important to recognize that NSAIDs, especially when taken in high doses or for a long period, can cause other serious side effects. These can include:

• Stomach pain, ulcers, or bleeding: NSAIDs can irritate the lining of your stomach, sometimes leading to ulcers or even gastrointestinal bleeding.
• Kidney damage: Prolonged or excessive use may impair kidney function, particularly in older adults or those with pre-existing kidney concerns.
• Liver damage: High doses or long-term use of NSAIDs can also affect liver health.

If you notice any signs of side effects such as persistent stomach pain, black or bloody stools, yellowing of the skin or eyes, or changes in urination, stop taking the medication right away and contact your healthcare provider.

COX-2 Inhibitors

A new class of NSAIDs is gaining wide acceptance for its ability to reduce inflammation.  Commonly called COX-2 inhibitors, these newer NSAIDs work by blocking the formation of pain-causing inflammatory chemicals.  Additionally, COX-2 inhibitors appear to be easier on the stomach, mainly because they don’t interrupt stomach enzymes like traditional NSAIDs. [American College of Physicians. (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline. Annals of Internal Medicine. https://www.acpjournals.org]

Muscle Relaxants

If you are having muscle spasms, muscle relaxants may help relieve pain.  They have only been shown to be partly effective.  Muscle relaxants also have a significant risk of drowsiness and depression.  Long-term use is not suggested; only three to four days is recommended.

Anti-depressants

Back pain is a common symptom of depression and could be an indicator of its presence.  Similarly, back pain can lead to distress and depression.  It seems that the same chemical reactions in the nerve cells that trigger depression also control the pain pathways in the brain.  Antidepressants can relieve the stress associated with back pain.  Some antidepressant medicines seem to reduce pain, probably because they affect this chemical reaction in the nerve cells.

Some types of antidepressants make good sleeping medications.  If you are having trouble sleeping due to your back pain, your doctor may prescribe an antidepressant to help you get back to a normal sleep routine.

How Anti-Depressants Help with Back Pain

Anti-depressants are typically prescribed for depression, but even if you don’t feel sad or depressed, low doses of these medications can help manage chronic low back pain. They work by altering the levels of certain brain chemicals, which change the way your brain processes pain signals. This dual effect—addressing both mood and pain—can be especially helpful if you’re struggling with sleep as well.

Some of the antidepressants most commonly used for back pain include:

• Amitriptyline
• Desipramine
• Duloxetine
• Imipramine
• Nortriptyline

Possible Side Effects

Antidepressants can have side effects such as drowsiness, loss of appetite, constipation, dry mouth, and fatigue. Other possible effects may include blurred vision, weight gain, sleepiness, problems urinating, and sexual issues. Rarely, some may also impact your heart or lung function.

Important: Only take antidepressants under the supervision of your healthcare provider. Never stop taking these medicines suddenly or adjust your dose without first consulting your provider.

Non-narcotic Prescription Pain Medications

Non-narcotic analgesics (pain relievers) are ideal in the treatment of mild to moderate chronic pain. For example, Tylenol™ and aspirin are the most widely used over-the-counter analgesics. Prescription options in this category include certain NSAIDs (nonsteroidal anti-inflammatory drugs), such as carprofen, fenoprofen, ketoprofen, and sulindac. These medications work by addressing pain at the point of injury.

Tips for Safe Use

• To help reduce possible side effects, avoid lying down for 15 to 30 minutes after taking these medications.
• Limit direct sun exposure while using NSAIDs; wear protective clothing and use sunblock.
• These medications are not recommended if you are pregnant, have a history of recurrent ulcers, or have liver problems.

Always follow your healthcare provider’s instructions and consult them with any concerns about your medications.

Precautions When Using Non-Narcotic Analgesics

When taking non-narcotic analgesics, it’s important to take several precautions to minimize potential side effects and ensure safe usage.

• Position After Consumption: Remain upright for 15 to 30 minutes after taking the medication to help reduce the risk of gastrointestinal issues.
• Sun Protection: Non-narcotic pain relievers can increase your sensitivity to the sun. To protect yourself, avoid prolonged exposure to direct sunlight. If you must be outdoors, wear protective clothing and apply sunscreen.
• Special Conditions: Certain groups of people should avoid these medications altogether. If you are pregnant, have a history of recurring ulcers, or suffer from liver problems, consult with your healthcare provider before using non-narcotic analgesics.

By following these guidelines, you can safely manage your pain while minimizing risks.

How to Manage the Side Effects of Narcotic Pain Medications

Narcotic pain medications are effective for managing severe pain, but they often come with side effects such as nausea, vomiting, constipation, and sleepiness. Fortunately, there are several strategies you can use to manage these side effects:
Avoid Combining Medications:

• Do not take sleeping aids or antidepressants with narcotic pain medications unless advised by a healthcare provider. Combining these can increase the risk of excessive drowsiness and other complications.

Limit Alcohol Consumption:

• Alcohol can exacerbate side effects like drowsiness and nausea. It’s best to avoid drinking alcohol while taking narcotic medications.

Increase Fluid Intake:

• Staying hydrated can help mitigate constipation, one of the most common side effects. Aim to drink at least 8 glasses of water a day.

Eat a High-Fiber Diet:

• Consuming foods rich in fiber, such as fruits, vegetables, and whole grains, can help maintain regular bowel movements and prevent constipation.

Use Laxatives or Stool Softeners:

• Consider using over-the-counter fiber laxatives or stool softeners if you experience constipation. These can assist in easing bowel movements.

Monitor Your Diet:

• Eating smaller, more frequent meals can help reduce nausea and vomiting. Ginger tea or peppermint may also soothe an upset stomach.

By following these guidelines, you can significantly reduce the occurrence of side effects while benefiting from the pain-relieving properties of narcotic medications. Always consult your healthcare provider for personalized advice before making any changes to your medication regimen.

Preventative Measures

These side effects are predictable and can often be prevented. Here are some common preventative measures:

• Avoid taking sleeping aids or antidepressants with narcotics
• Avoid alcohol
• Increase fluid intake
• Eat a high-fiber diet
• Use a fiber laxative or stool softener to manage constipation

Always consult your healthcare provider for personalized advice, especially when dealing with severe pain and potent medications like narcotics.

We will Safely Care for You.

Our top goals at Southwest Scoliosis and Spine Institute, with offices in Dallas, Plano, and Frisco, Texas, are your health and safety. In our hospitals, surgery centers, and in-person clinics, we are prepared to care for you and your family. You don’t have to make decisions alone if you need help to stop back pain. One of our primary duties is to help you learn about the pros and cons of medical procedures and medicines to help you. Our staff remains available to answer questions, provide support, and reassure you that you are receiving the best possible medicines and care for your back or neck pain.

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Citations: Harvard Medical School – Medications for Back Pain

The medical content on this page has been carefully reviewed and approved for accuracy by the Southwest Scoliosis and Spine Institute’s qualified healthcare professionals, including our board-certified physicians and Physician Assistants. Our team ensures that all information reflects the latest evidence-based practices and meets rigorous standards of medical accuracy, with oversight from our expert spine doctors to guarantee reliability for our patients.