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Medicines for back pain

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Acute back pain often goes away on its own over several weeks. In some people, back pain persists. It may not go away completely or it may get more painful at times.

Medicines can help with your back pain.

OVER-THE-COUNTER PAIN RELIEVERS

Over-the-counter means you can buy them without a prescription.

Most health care providers recommend acetaminophen (such as Tylenol) first because it has fewer side effects than other medicines. Do not take more than 3 grams (3,000 mg) on any one day, or over 24 hours. Overdosing on acetaminophen can cause severe damage to your liver. If you already have liver disease, ask your provider if acetaminophen is OK for you to take.

If your pain continues, your provider may suggest nonsteroidal anti-inflammatory drugs (NSAIDs). You can buy some NSAIDs, such as ibuprofen and naproxen, without a prescription. NSAIDs help reduce the swelling around the swollen disk or arthritis in the back.

NSAIDs and acetaminophen, when taken in high doses or for a long time, can cause serious side effects. Side effects include stomach pain, ulcers or bleeding, and kidney or liver damage. If side effects occur, stop taking the medicine right away and tell your provider.

If you are taking pain relievers for more than a week, tell your provider. You may need to be watched for side effects.

NARCOTIC PAIN RELIEVERS

Narcotics, also called opioid pain relievers, are used only for pain that is severe and is not helped by other types of painkillers. They work well for short-term relief. Do not use them for more than 3 to 4 weeks unless instructed by your provider to do so.

Narcotics work by binding to receptors in the brain, which blocks the feeling of pain. These medicines can be abused and are habit-forming. They have been associated with accidental overdose and death. When used carefully and under a provider's direct care, they can be effective in reducing pain.

Examples of narcotics include:

• Codeine
• Fentanyl -- available as a patch
• Hydrocodone
• Hydromorphone
• Morphine
• Oxycodone (Oxycontin)
• Tramadol

Possible side effects of these medicines include:

• Drowsiness
• Impaired judgment
• Nausea or vomiting
• Constipation
• Itching
• Slowed breathing
• Addiction and withdrawal symptoms

When taking narcotics, do not drink alcohol, drive, or operate heavy machinery.

MUSCLE RELAXANTS

Your provider may prescribe a medicine called a muscle relaxant. Despite its name, it does not work directly on muscles. Instead, it works through your brain and spinal cord.

This medicine is often given along with over-the-counter pain relievers to relieve the symptoms of back pain or muscle spasm.

Examples of muscle relaxants include:

• Carisoprodol
• Cyclobenzaprine
• Diazepam
• Methocarbamol

Side effects of muscle relaxants are common and include drowsiness, dizziness, confusion, nausea, and vomiting.

These medicines can be habit-forming. Talk to your provider before using these medicines. They may interact with other medicines or make certain medical conditions worse.

Do not drive or operate heavy machinery while taking muscle relaxants. Do not drink alcohol while taking these medicines.

ANTIDEPRESSANTS

Antidepressants are normally used to treat people with depression. But, low doses of these medicines can help with chronic low back pain, even if the person does not feel sad or depressed.

These medicines work by changing the levels of certain chemicals in your brain. This changes the way your brain notices pain. Antidepressants most commonly used for chronic low back pain also help you sleep.

Antidepressants most often used for back pain are:

• Amitriptyline
• Desipramine
• Duloxetine
• Imipramine
• Nortriptyline

Common side effects include dry mouth, constipation, blurred vision, weight gain, sleepiness, problems urinating, and sexual problems. Less commonly, some of these medicines can also cause heart and lung problems.

Do not take these medicines unless you are under the care of a provider. Do not stop taking these medicines suddenly or change the dose without also talking with your provider.

ANTI-SEIZURE OR ANTICONVULSANT MEDICINES

Anticonvulsant medicines are used to treat people with seizures or epilepsy. They work by causing changes in the electric signals in the brain. They work best for pain that is caused by nerve damage.

These medicines may help some people whose long-term back pain has made it hard for them to work or pain that interferes with their daily activities. They can also help relieve radiating pain that is common with back problems.

Anticonvulsants most often used to treat chronic pain are:

• Carbamazepine
• Gabapentin
• Lamotrigine
• Pregabalin
• Valproic acid

Common side effects include weight gain or weight loss, upset stomach, loss of appetite, skin rashes, drowsiness or feeling confused, depression, and headaches.

Do not take these medicines unless you are under a provider's care. Do not stop taking these medicines suddenly or change the dose without also talking with your provider.

References

Corwell BN, Davis NL. Back pain. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 31.

Dixit R. Low back pain. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 50.

Malik K, Nelson A. Overview of low back pain disorders. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP, eds. Essentials of Pain Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 24.

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Review Date: 4/24/2023  

Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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