Medications for Back Pain

Medications for Back Pain

The Whole Gamut of Medications for Back Pain: From Vicodin to Marijuana

Your doctor may prescribe NSAIDs for back pain. These NSAIDs for back pain are one type of pain killer type of medications.

Painkillers fall into the general category of analgesics. There are several different categories including the following:

• non-steroidals (NSAIDs)

• acetaminophen

• opioids

• tramadol-related products

However, some painkillers may also be classified into other categories. Some medications may be used to treat other diseases, but they have been found to also relieve back pain, and doctors may choose to use them for your condition.

Prescription Medications / Anti-Inflammatory Drugs

Non-steroidal anti-inflammatory (NSAID) drug are often prescribed along with a muscle relaxant for back pain. NSAIDs can begin to decrease the inflammation so that healing can start.

Some examples of NSAIDs include:

• aspirin                              • ibuprofen (Motrin)                 •ketoprofen (Actron)

• naproxen (Alieve)          • nabumetone(Relafen)           • piroxicam (Feldene)

• meloxicam(Mobic)        • celecoxib (Celebrex)              • ketoralac (Toradol)

NSAIDs interfere with the action of an enzyme called cyclooxygenase (COX) in the body. This enzyme converts one of the fats you get in your diet, arachidonic acid, to chemicals called prostaglandins. The prostaglandins cause inflammation in the body; thus, by inhibiting them, pain relief is felt. They can work synergistically with opioids.

Muscle Relaxants and Anti-Epilepsy Drugs

Doctors discovered that by giving drugs that reduce seizures, it could have some positive effects for back pain. These medications work by altering the nerve function so that some of the messages are still sent by the nerve while others are suppressed.

• gabapentin (Neurontin)        • carbamazeprine (Tegretol)

• pregabalin (Lyrica)                • topiramate (Topamax)

• lamotrigine (Lamictal)

Some side effects include dizziness, edema (swelling) in the arms and legs, lack of coordination and drowsiness.

Muscle relaxants will force the muscles to relax which can remove some of the pressure on nerves from tight muscles. They also relax the brain.  Some examples of muscle relaxants include the following:

• methocarbamol (Robaxin)             • cyclobenzaprine(Flexeril)

• metaxalone (Skelaxin)                      • carisoprodol(Soma)

• diazepam (Valium)                             • tizanidine (for headaches) (Zanaflex)

Treatment with NSAIDs and muscle relaxants can be effective but when they don’t work, referral to a neurologist or physical medicine and rehabilitation specialist is indicated.

Side Effects of NSAIDs and Muscle Relaxants

One thing to remember about NSAIDs and muscle relaxants is that they are not meant for long-term usage. Both types of medication have side effects associated with them.

Here’s a list of what to watch for:

• Ulcers of the stomach lining, causing internal bleeding

• Permanent kidney damage, or decrease in kidney function

• Permanent liver damage

• Nausea and vomiting

• Heartburn

• Swelling of the feet/ankles

• Muscle pain / weakness

• Bruising / bleeding

• Abdominal pain

• Dizziness

• Drowsiness

• Diarrhea / constipation

• Allergic reaction

• Heart failure

• Paralysis

• Confusion

• Dry mouth

• Blurred Vision

• Fatigue

• Hallucinations

• Difficulty urinating

• Lack of appetite

• Seizures

• Loss of coordination

• And more!

Tramadol

This medication also goes by the names, Ultram and Ultracet (when tylenol is added). This medication for back pain increases serotonin and norepinephrine, binding to the opioid receptors. It is used for moderate to severe pain, especially those with chronic low back pain, and those who can’t take NSAIDs or they have become ineffective.

Tramadol is about 20% as strong as morphine. Effects can be felt for about six hours on average.

Side effects of tramadol include:

• Dizziness

• Nausea and vomiting

• Constipation

• Fatigue

• Seizures

• Confusion

Opioids for Back Pain

These medications are addictive and should not be used unless there has been no relief from other pain medications.  They bind to central nervous system receptors in the cell membranes. In addition to being addictive, your body quickly becomes tolerant to the medication and it takes more and more opiod medication to have the same effect. For these reasons, there are no studies that show it is effective for long term.

Class II Opiods (Most Addictive)

Oxycodone (oxycontin, Percocet, Percodan)

Codeine

Methadone

Oxymorphone (Opana)

Morphine

Meperidine (Demerol)

Hydromorphone (Dilaudid)

Fentanyl (Fentora)

Tapentadol (Nucynta)

Class III Opiods

Codeine (Tylenol 2,  3 and 4)

Hydrocodone (Lorcet, Lortab, Norco, Vicodin)

Buprenorphine and Naloxone (Suboxone)

Class IV Opiods

Propoxyphene (Darvon, Darvocet)

When using these medications for back pain, it’s recommended to take them orally so that the dosage can be changed more easily.

Opiod Side Effects

• Constipation

• Nausea and vomiting

• Sedation

• Itching

• Decreased testosterone (low libido)

• Muscle jerking or contracting (from too high of a dose)

• Addiction seen in 10% of the population taking them

When someone is taking any of these regulated drugs, he or she must agree not to give the medication to anyone else or seek another physician for the same prescription. Also the person may not take the medication any way other than what is written on the bottle. Sometimes the agreement must be signed and placed in the person’s medical chart.

Although opiods do decrease pain, you will have to decide yourself whether or not it is worth the risk to take them. An opioid will decrease your pain but it will do little to address the cause of your problem.  There are other complications of these medications for back pain. See Medical Treatment page.

Medical Marijuana

Doctors in various states are now prescribing medical cannabis for pain control, including back pain. This is becoming another viable option; however, it has become a political battle. For example, when it became legal in the state of California for doctors to prescribe medical cannabis to those with back pain and other disorders, marijuana clinics started sprouting up on many street corners.

Critics say that it’s not really ethical for a parent to be smoking marijuana in front of their children and that these clinics should not be close to schools.  They also say that just having these clinics in the neighborhood is an invitation to criminals who want to raid them. Medical marijuana clinics hire armed guards, but this hasn’t necessarily stopped criminals from breaking in to “take the stash”.

Nevertheless, marijuana clinics are now offering patients choices for how they can consume the marijuana:

• in foods such as brownies, puddings, ice cream, candy, and beverages

• through a transdermal skin patch

• cigarettes and bongs

• massage oils

Their patients report that they do experience less back pain. Research studies substantiate the science behind the cannabinoids in marijuana for effective pain control. Meanwhile, pharmaceutical companies are trying to mimic the compounds in the plant to create drugs that can be used instead of the plant.

Should marijuana be included amongst the medications for back pain? What’s your idea?