Low back pain is a common condition that affects millions of people all over the world. There are a number of different factors that can cause low back pain including muscle strains and sprains, injuries, and degenerative conditions.
Unfortunately, the exact cause of low back pain can be hard to determine, making it one of the most challenging conditions to treat.
What Medications Do The Guidelines Recommend For Low Back Pain?
When it comes to managing low back pain, international guidelines often recommend exercise therapy and over the counter medications as first line therapy. But with so many different types of medications to choose from, how do you know which are the best medications for low back pain?
There is No One-Size-Fits-All Back Pain Solution
The question often depends on what sort of pain you are experiencing as well as what your individual response to medication is. There is no one-size fits all solution or magic pill to take to cure low back pain. In this blog we take a look at some of the most common classes of medications and their pros and cons for managing low back pain.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
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
These medications can be purchased over the counter - meaning that you don’t need a prescription for them - which makes them easily available for those who are experiencing an episode of low back pain. It also means that they can be taken as needed.
Cons
Because these drugs are so readily available and people think that they aren’t “serious” drugs, there is a tendency for people to over use them. Unfortunately, like most medicines they are not completely risk free.
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?
Unfortunately NSAIDs may not be the answer that you are looking for. A study published in 2017 in the Annals of the Rheumatic Diseases looked at 35 different studies that included more than 6,000 with different types of spine-related pain like sciatica, low back pain and neck pain.
While the people who took NSAIDs had less pain after starting treatment, there wasn’t much difference between their pain levels and the people who got a placebo (a fake pill). What’s more, the people who took NSAIDs were two-and-a-half times more likely to experience side effects.
When taking NSAIDs it is important to pay attention to dosage, side effects, and be aware that they don’t work for everyone.
Muscle Relaxants
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.
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 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.
Cyclobenzaprine and methocarbamol are other common muscle relaxants that are prescribed for low back pain.
Pros
These medications like cyclobenzaprine and diazepam have been found to work quickly to reduce muscle spasms.
Cons
Available only by prescription, both types of medications are considered to be sedatives and can make you extremely drowsy. They can also be highly addictive with a challenging withdrawal process and therefore require careful monitoring.
Muscle relaxants can also cause dizziness and sleep issues, affecting your ability to drive and leading to an increased risk of falling in older people.
Do They Work?
Muscle relaxants can relieve acute back pain, but only for the short term. As yet, there is not enough data to show their effectiveness for chronic low back pain.
Because of their high side effect profile and the serious risk of addiction, many guidelines do not recommend the use of muscle relaxants for managing low back pain.
Opioids
Opioids are a class of medications that have historically been used to treat moderate to severe low back pain. Some types of opioids include oxycodone, hydrocodone, and fentanyl. These medications work by binding to the body’s opioid receptors, reducing pain and helping patients go about their daily lives.
Pros:
Opioids can be an effective option for low back pain when they are taken for a short time.
Cons:
Opioids are highly addictive and have been the cause of many an overdose. Because of this, they are available only by prescription and their use is now highly monitored. They are not a good long term option for managing low back pain.
Do They Work?
The use of opioids for back pain is a highly controversial topic with most guidelines recommending against the use of these medications. 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. Guidelines recommend that they be considered only as a last resort.
Antidepressants
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:
Although they are only available by prescription, antidepressants are not addictive and they are often well tolerated by back pain patients. They can have a double bonus of treating depression which has been shown to increase people’s feelings of pain.
Cons:
Antidepressants are a longer-term therapy and can take some time to work. They also require supervision and often a tapering-off process if you want to stop taking them. They are not necessarily the best option for acute pain management and they can be expensive.
Conclusions
Generally speaking, international guidelines recommend a combination of medications and physical therapy to manage low back pain safely and effectively. What type of medication you decide to take is a decision that is best made between you and your healthcare provider.
Discussing medication options with your doctor is always a good idea since they will know what your medical history is, if you have any allergies, and if you are taking any other medications that may interact with some of the medications we have listed above.
Non-Medication Options
If you have any type of concern about using these medications for your low back pain you may want to consider some of the tried and trusted non-medication treatment options. These include treatments like:
Meditation
Trying out some of these evidence-based recommended therapies, you might find that the best medications for low back pain aren’t medications at all.