A Look at Medication Options for Back Pain

Published by Contra Costa Times

Posted on Wed, Oct. 04, 2006

By Dr. Stephen J. Daniels

"DR. DANIELS, I need something strong for my back pain. It's really hurting."

A common statement by a patient suffering from back pain. So what kinds of medicines are used to treat back pain?

By far the safest medicine is Tylenol or its generic equivalent. For many patients, Tylenol can relieve back pain. It should not be taken with alcohol, and can cause kidney damage in the elderly or if taken for years on a regular basis.

A second type of medication doctors prescribe for back pain are the NSAIDs or non-steroidal anti-inflammatory drugs.

The NSAIDs can reduce inflammation and pain, without most of the serious side effects of steroids, even if taken for many years. NSAIDs include Motrin, Advil, Naprosyn, Relafen, Mobic, Celebrex and many others.

NSAIDs can have side effects, including stomach irritation, and stomach bleeding. They can raise blood pressure, and can damage the kidneys, especially after prolonged use.

Steroids such as prednisone are the strongest anti-inflammatory drugs available. Some doctors prescribe a short course for acute injuries (usually for less than two weeks) with excellent benefit. Ask your doctor about this.

The next type of medication used for back pain are the muscle relaxants. These include Robaxin, Baclofen, Flexeril (cyclobenzaprine) and Soma.

Although called "muscle relaxants," not all these medications have been shown to relax muscles in humans. In most cases, their mechanism of action for helping pain in unknown. Many patients find them quite helpful, however.

Patients often benefit from a high initial dose of Robaxin (6-8 grams per day), but after two to three days, the dose can be reduced to about 4 grams per day. Robaxin generally has few side effects, and some patients find it quite effective.

Baclofen is approved for the muscle spasticity associated with multiple sclerosis, but can also be used to treat back pain.

Baclofen is often taken in low doses initially. Then the dose is gradually increased until the maximum safe dose is reached or side effects prevent further increases.

It can raise blood sugar in diabetics, and should be stopped by gradually decreasing the dose over a week or two.

Flexeril is only recommended for the first three weeks of back pain, but some patients seem to benefit from it on a long-term regular basis. It can cause drowsiness, and should be used with caution by those with heart disease, especially irregular heart rhythms or abnormal EKGs.

Soma seems to be quite effective in helping back pain, but because it is habit-forming, many doctors are reluctant to use it, especially long-term.

After ingested, Soma is converted by the liver into a tranquilizer called meprobamate. Soma may work mostly as a sedative or tranquilizer.

The next type of medications commonly ordered to treat back pain are the narcotics. In order of increasing potency, these include codeine, hydrocodone (vicodin), oxycodone (percocet, oxycontin), morphine, hydromorphone (dilaudid), methadone, and fentanyl (durgesic).

It is commonly known that these medicines can be habit-forming and even addicting, especially if taken for long periods. Despite this, many patients benefit from them for either short- or long-term use.

We will discuss narcotic treatment in detail in future Healthy Outlook columns.

Dr. Daniels practices family medicine at the Pittsburg and Concord Health Centers.