Medicines for low back pain

Over-the-counter pain medicines

You can buy over-the-counter (OTC) medicines without a prescription. Some OTC pain medicines may help with your back pain.

Most health care providers recommend taking acetaminophen (such as Tylenol) first. This is because it has fewer side effects than other drugs. DO NOT take more than 4 grams (4,000 mg) in a 24-hour period. Taking more than that amount is likely to cause severe and permanent damage to your liver.

If acetaminophen does not ease your back pain, your provider may suggest nonsteroidal anti-inflammatory drugs (NSAIDs). You can buy some NSAIDs, such as ibuprofen (Advil and Motrin IB) and naproxen (Aleve), without a prescription.

If you take high doses of NSAIDs for a long time, you may get serious side effects. Some of these are:

• Stomach ulcers or bleeding in your stomach
• Liver or kidney damage

Tell your provider if you are taking OTC pain relievers on most days. Your provider may want to start checking you for side effects.

Muscle relaxants

Sometimes providers prescribe drugs called "muscle relaxants" for back pain. Their name makes it sound like they work directly on muscles, but they don't. Instead, they affect your brain and spinal cord nerves.

Some people take both muscle relaxants and OTC pain relievers to relieve sharp back pain or muscle spasms. A spasm is a period of severe pain that is caused by your muscles getting tighter on their own.

Some names of muscle relaxants are:

• Carisoprodol (Soma) -- this drug may be more addictive than the others on this list.
• Cyclobenzaprine (Flexeril).
• Diazepam (Valium).
• Methocarbamol (Robaxin).

Side effects from muscle relaxants are common. Some side effects are feeling sleepy or confused and being sick to your stomach or throwing up.

Some people become addicted to muscle relaxants. Talk with your provider before you start using them. Also, be sure your provider knows what other medicines you take, because these drugs may react with other medicines. This can make certain medical conditions worse.

DO NOT drive or operate heavy machinery while you are taking muscle relaxants. Also, do not drink alcohol or use street drugs while you are taking these medicines.

Antidepressants

Antidepressants are normally used to treat depression. But lower doses of these medicines can help some people with long-term low back pain, even if they are not sad or depressed.

Antidepressant medicines work by changing the levels of some chemicals in your brain. This changes the way your brain reacts to or feels pain.

Many people with long-term pain have trouble sleeping. Taking antidepressants may help treat your pain and your sleep problems. The antidepressants that are used most for long-term low back pain also help people sleep better.

The antidepressants that are used most often for back pain are:

• Amitriptyline (Elavil, Endep)
• Desipramine (Norpramin)
• Duloxetine (Cymbalta, Irenka)
• Doxepin (Sinequan)
• Imipramine (Tofranil)
• Nortriptyline (Pamelor, Aventyl)

Antidepressant medicines have some side effects. Some common side effects are:

• Dry mouth
• Problems urinating
• Blurred vision
• Sexual problems
• Not being able to have a bowel movement easily (being constipated)
• Weight gain
• Sleepiness
• Heart and lungs problems, but this is less common

DO NOT take antidepressant drugs unless you are under the care of a provider. Also, DO NOT stop taking these drugs suddenly or change your dose without talking with your provider.

Antiseizure or anticonvulsant medicines

Anticonvulsant medicines are used to prevent convulsions (intense muscle movements that a person cannot control). They treat people who have seizures or epilepsy. These medicines work by changing the electric signals in the brain. They work best for pain that is caused by nerve damage.

These drugs may help some people who have long-term back pain that makes it hard to work or do daily tasks.

The most common anticonvulsants for treating chronic pain are:

• Carbamazepine (Tegretol)
• Gabapentin (Neurontin)
• Lamotrigine (Lamictal)
• Pregabalin (Lyrica)
• Valproic acid (Depakene or Depakote)

Each of these drugs has different side effects. Some of the more common side effects are:

• Weight loss or gain
• Nausea
• Loss of appetite
• Skin rashes
• Sleepiness or confusion
• Headaches

DO NOT take these drugs unless you are under the care of a provider. Also, DO NOT stop taking these drugs suddenly or change your dose without talking with your provider.