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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 instances, 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.
  • If you have a kidney 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. Prescription versions can be 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), Ketorolac (Toradol) and tolmetin (Tolectin). These drugs can increase your risk for stomach ulcers and bleeding. They may also raise your blood pressure and damage your kidneys.
  • COX-2 inhibitors -- This is a selective NSAID that reduces inflammation and pain. This medicine is safer for your stomach. The only NSAID currently available is celecoxib (Celebrex). Serious questions have been raised about the safety of COX-2 inhibitors. Two of these drugs were pulled from the market. The FDA ordered the manufacturer of celecoxib to add a warning to the drug's label indicating the drug may increase the risk for heart problems or stroke.
  • 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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NSAIDs

COX-2 Inhibitors

Narcotics

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. These medications have the potential for abuse and addiction, particularly if they are taken for a long period of time. Drowsiness is a common side effect.

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Muscle Relaxants

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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Review Date: 6/29/2011
Reviewed By: Andrew W. Piasecki, MD, Camden Bone and Joint, LLC, Orthopaedic Surgery/Sports Medicine, Camden, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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