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| Step 11: Medications |
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There are a variety of options for medications. Together, you and your doctor will figure out what will work best.
Over-the-counter drugs
It is best to start with the mildest medications available. Your doctor will likely tell you to try acetaminophen (Tylenol), aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve) initially. You don't need a prescription for these drugs. Many people tolerate them well for a short period of time. There are a few reasons, however, when you should not take these medicines:
- If you have a history of bleeding from your stomach, an ulcer, or inflammation of your stomach or elsewhere along your digestive tract.
- If you drink alcohol regularly or have a history of a liver disorder.
Prescription pain relievers
If over-the-counter medications are not enough for the pain, your doctor may consider prescription pain relievers. These include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) -- Over-the-counter ibuprofen is an NSAID. The prescription versions, however, are generally stronger and longer acting. Drugs in this class include diclofenac (Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis, Oruvail), nabumetone (Relafan), naproxen (Anaprox, Naprosyn), piroxicam (Feldene), salsalate (Disalcid), sulindac (Clinoril), and tolmetin (Tolectin). In addition to the potential for ulcers and bleeding, these drugs can increase your blood pressure.
- COX-2 inhibitors -- These are selective NSAIDs that reduce inflammation and pain. They are safer for your stomach, however, and tend to have fewer side effects. An example is celecoxib (Celebrex). However, serious questions have been raised in regards to the safety of COX-2 inhibitors. Two such drugs have been pulled from the market, and the FDA has asked the manufacturer of celecoxib to add a strict warning to its label alerting users to the potential for increased heart-related events.
- Narcotics -- Drugs in this category include codeine, meperidine (Demerol), morphine (MS Contin), oxycodone (Percocet, Percodan), and tramadol (Ultram). These medications often cause constipation and can be addictive. Although they relieve pain, they do not generally improve activity level.
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Muscle relaxants
If pain relievers alone are not enough, your doctor may consider a type of drug called a muscle relaxant, especially if you have a lot of muscle spasm (tension in your muscles). Examples of muscle relaxants include:
- Cyclobenzaprine (Flexeril)
- Diazepam (Valium)
- Carisoprodol (Soma)
- Methocarbamol (Robaxin)
Interestingly, muscle relaxants don't actually work at the muscles. They work by telling your brain to relax the muscles. Because they affect the brain, you may become addicted to these medications if they are taken for a long period of time. Drowsiness is a common side effect.
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Steroid injections
If your back pain persists for longer than a month, your doctor may consider injecting a steroid drug in the area of the pain. This medication reduces inflammation and pain. The doctor may consider this if you have a trapped nerve. Sciatica is an example of back pain with a trapped nerve. A nerve may also become trapped if you have a herniated disk.
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Reviewed By: Fabian Arnaldo, M.D., Department of Internal Medicine, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.
