The Best Medications For Low Back Pain

Low back pain is a common condition that affects millions of people worldwide. Causes range from simple muscle strains to more complex issues like degenerative conditions.

Unfortunately, the exact source of low back pain is often difficult to pin down, making it one of the most challenging conditions to treat. About 40–90% of people recover within 6 weeks, but for many individuals, the pain often lingers longer than expected .

What Medications Do The Guidelines Recommend For Low Back Pain?

International guidelines (such as those from the American College of Physicians and NICE UK) recommend:

• First-line care: exercise therapy, staying active, and self-care strategies.

• Medications: NSAIDs as the most common short-term option.

• Other drugs: only in select cases, when pain is severe or persistent.

  
  

But with so many choices, which medications actually work best?

There is No One-Size-Fits-All Back Pain Solution

When it comes to managing back pain, treatment often depends on things like:

• Whether your pain is acute or chronic

• Your individual response to medications

• Side effects and your overall health history

  
  

There’s no magic pill or one-size fits all solution. Instead, let’s walk through the main medication options and weigh their pros and cons.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Examples: ibuprofen, naproxen, diclofenac

NSAIDs are one of the most commonly prescribed medications for low back pain and are often the go-to drugs for back pain relief. These medications (like ibuprofen and naproxen) work by reducing levels of inflammation and pain in the body.

Pros

• Widely available over the counter

• Reduce inflammation and pain

• Can be taken as needed

  
  

Cons

• Easy to overuse (“they’re just ibuprofen”)

• Long-term use risks: stomach ulcers, GI bleeds, kidney problems, cardiovascular issues

  
  

Long Term Concerns Of NSAID Use

The long-term use of NSAIDs can lead to possible side effects like stomach pains, ulcers, bleeds, kidney problems, and even cardiovascular risk.

If you are going to use these medications is it important to follow the guidelines on the labels and let your doctor know what you are taking, how much you are taking, if you are taking any other products that may interact with it, and for how long you have been taking it.

Do They Work?

A 2017 meta-analysis (6,000+ patients, Annals of the Rheumatic Diseases) found NSAIDs provided small benefits—reducing pain by about 7 points on a 0–100 scale and disability by about 2 points on a 0–24 scale .However, users were 2.5x more likely to experience side effects.

Takeaway: NSAIDs can help in the short-term, but they’re not a cure and should be used carefully.

Muscle Relaxants

Examples: cyclobenzaprine, methocarbamol, diazepam

Another class of medications commonly used to treat low back pain are muscle relaxants. Muscle relaxants are a class of drug that acts on the central nervous system to help with acute, short term pain.

Can I Use Muscle Relaxants For Back Spasms?

This type of medication is often recommended for people that are experiencing muscle spasms, like low back spasms. Muscle spasms can be excruciatingly painful and they happen when the muscles in your back and around your bones involuntarily contract or tighten.

Muscles spasms are actually one of the main causes of low back pain, but they generally resolve on their own after a few weeks. Some spasms can be relatively mild, while others are dreadfully debilitating. While some people are able to wait them out, others may find themselves needing some type of medication to help them get through the day.

How Do Muscle Relaxants Work?

These drugs work by relaxing the muscles, which can help to reduce pain and improve mobility. They help with low back pain by affecting the nervous system and altering the way that nerve impulses are sent to the muscles.

There are two main types of muscle relaxants: centrally acting muscle relaxants and peripherally acting muscle relaxants.

Centrally acting muscle relaxants: Medications like cyclobenzaprine, work by impacting the brain and spinal cord. These drugs bind to specific receptors in the central nervous system, which in turn affects the way that nerve impulses are sent to the muscles.

Peripherally acting muscle relaxants: Drugs like dantrolene, work by affecting the muscles and nerves directly.

Pros

• Often work quickly for painful spasms

• Improve short-term mobility

Cons

• Prescription only

• Sedating; can cause dizziness and drowsiness

• Risk of dependence and withdrawal

• Increase fall risk in older adults

Do They Work?

Studies suggest modest benefits for acute low back pain in the first 2 weeks (pain reduction ~7–8 points on a 0–100 scale). Unfortunately there is not enough data yet to show their effectiveness for chronic low back pain.

 A 2025 review found non-benzodiazepine muscle relaxants increased the chance of pain relief but it also found that they raised the side effect risk by 56%. Because of this increased side effect profile, and the high risk of addiction, most guidelines do not recommend using muscle relaxants to manage chronic low back pain.

Takeaway: Muscle relaxants can be helpful short-term, but not a good long-term solution.

Opioids

Examples: oxycodone, hydrocodone, fentanyl

Opioids are a class of medication that have historically been used to treat moderate to severe low back pain. These medications work by binding to the body’s opioid receptors, reducing pain and helping patients go about their daily lives.

Pros

• Can help in cases of severe acute pain

• May allow patients to get through daily tasks when nothing else works

Cons

• Highly addictive, with overdose risk

• Not suitable for long-term use

• Only work for <30% of patients with non-cancer pain

Do They Work?

Because of their risks, most guidelines recommend against routine use of opioids for back pain. They should only ever be considered a last resort under close medical supervision. Some studies have also found that opioids work for less than 30% of people when used for treating pain that isn’t related to cancer.

Antidepressants

Examples: duloxetine, amitriptyline

Some antidepressants, like amitriptyline and duloxetine, have been found to be effective in treating chronic low back pain. Antidepressants work for pain by increasing the levels of certain neurotransmitters in the brain, which can help to reduce pain and improve mood. These medications also help manage symptoms of depression which can be a contributing factor to low back pain.

Pros

• Non-addictive

• Address both pain and depression together

Cons

• Only available by prescription

• Slow onset (weeks to work)

• Require tapering when stopping

• May be costly

Do They Work?

Research shows antidepressants like duloxetine can improve both pain and function in chronic low back pain patients. They are not first-line for acute pain, but they can be a good option for long-term management.

Takeaway: Best suited for chronic pain, especially when mood symptoms are involved.

Comparing Medications

Medication Class	Best For	Risks & Side Effects	Guideline View
NSAIDs	First-line, acute pain	GI issues, kidney, heart risks	Yes (short-term use)
Muscle Relaxants	Acute spasms	Sedation, dependence, dizziness	Limited (short-term)
Opioids	Severe acute pain	Addiction, overdose	Avoid (last resort)
Antidepressants	Chronic pain + depression	Side effects, tapering required	Consider selectively

Non-Medication Options

If you’re hesitant about medications, or perhaps you just want to reduce reliance on them, you could try some of these proven strategies:

• Physical therapy / Digital physical therapy

• Exercise programs (yoga, stretching, strength training)

• Biofeedback therapy

• Cognitive Behavioral Therapy (CBT)

• Mindfulness-Based Stress Reduction (MBSR)

• Meditation

  
  

Many studies show that movement and behavioral therapies can provide as much—if not more—relief than medications for many patients.

Sometimes, the best “medications” for low back pain aren’t medications at all.

Conclusions

There’s no single best pill for low back pain. The safest, most effective approach is a combination of:

• Lifestyle changes and physical therapy

• Short-term, careful use of medications (when needed)

• Honest discussions with your healthcare provider

  
  

Your doctor can help guide the choice based on your medical history, risks, and preferences.

FAQ: Best Medications for Low Back Pain

Q: What’s the safest first option?

A: NSAIDs like ibuprofen or naproxen are usually recommended first, in the lowest effective dose for the shortest time possible.

Q: Can muscle relaxants work better than NSAIDs?

A: They may work faster for spasms, but only short-term and with higher side effect risks.

Q: Are opioids ever safe for back pain?

A: Rarely. Guidelines recommend them only as a last resort under strict monitoring.

Q: Do antidepressants actually reduce pain?

A: Yes—duloxetine and amitriptyline can reduce chronic pain, particularly when depression is also present.

Q: Can I manage back pain without medications?

A: Yes. Exercise, physical therapy, mindfulness, and CBT are all highly recommended, evidence-based strategies.