A Guide to Different Back Pain Medications

Medically Reviewed By Philip Ngo, PharmD

Back pain medications include nonsteroidal anti-inflammatory drugs, muscle relaxants, steroids, topical medications, and more. Which one is best for you will depend on what has caused your pain, other health conditions you may have, your lifestyle, side effects, and other factors. Some medications are appropriate for short-term use only, while others may work long-term.

Your doctor will consider the risks and benefits of any medication for your specific situation. You can work with them to create a treatment plan that includes medications and possibly other treatments like exercise, physical therapy, or chiropractic care.

It is important to take medications as directed and tell your doctor about all medications and supplements you are taking.

Read on to learn more about these medications. This can help you and your doctor choose the medication that is right for you.

Nonsteroidal anti-inflammatory drugs

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely prescribed medications for back pain.

Most NSAIDs are available as oral medications, including ibuprofen (Advil) and naproxen (Aleve). Some may be injectable or topical.

NSAID medications decrease inflammation and provide pain relief by inhibiting (blocking) an enzyme called cyclooxygenase (COX). This enzyme has two forms, COX-1 and COX-2.

Side effects

Major NSAID side effects may not be common but include:

  • stomach upset, especially with those that inhibit COX-1, as this enzyme is important in protecting membranes in the stomach
  • bleeding, especially in people who have a history of gastric ulcers or diseases that affect platelets
  • kidney damage, especially in people who already have compromised kidney function

People who have known allergic reactions to NSAIDs or aspirin, those in the third trimester of pregnancy, and those who have undergone coronary artery bypass grafts should not take NSAIDs.

Learn more about NSAIDs.

Acetaminophen

Acetaminophen is the active ingredient in Tylenol. It is the most common pain reliever used worldwide and is recommended as the first medication to treat mild to moderate pain.

Acetaminophen’s mechanism of action is not completely understood, but it may raise the pain threshold by decreasing a neurotransmitter called substance P. This neurotransmitter affects the way pain signals Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source are regulated in the body.

Acetaminophen can also inhibit Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source the COX pathway, which plays a big role in inflammatory pain. However, NSAIDs may do this more.

According to 2019 research, some studies have shown that acetaminophen has little effect on back pain.

For pregnant people, acetaminophen is a preferable pain reliever to NSAIDs.

Antidepressants

Doctors commonly prescribe several categories of antidepressant medications for back pain. These include:

Selective norepinephrine reuptake inhibitors (SNRIs)Tricyclic antidepressants (TCAs)Norepinephrine–dopamine reuptake inhibitors (NDRIs)Serotonin antagonist and reuptake inhibitors (SARIs)Tetracyclic antidepressants
duloxetine, milnacipranamitriptyline, nortriptylinebupropiontrazodonemaprotiline

These medications are endorsed by roughly 75% of clinical guidelines, but a 2021 analysis Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of 33 studies done on 5,318 people with chronic back, hip, or knee pain showed them to be largely ineffective. The study did show a small positive effect on osteoarthritis pain.

Some of these medications may also have significant side effects. Stopping them abruptly can cause withdrawal symptoms like sleeplessness, nausea, and anxiety.

Read our tips for choosing a pain medicine doctor.

Anticonvulsants

The use of anticonvulsant medications for chronic back pain has increased Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source . This may be due to the need to find alternatives to opioids.

Anticonvulsants used for back pain include:

Effectiveness and side effects

One large analysis showed that these medications are largely ineffective against chronic back pain. They also have a risk of side effects, including drowsiness, dizziness, and nausea.

Muscle relaxants

Skeletal muscle relaxants are a class of drugs that relieve spasms, which can be extremely painful.

Muscle relaxants are prescribed extensively for back pain. It is best to use them temporarily for acute pain rather than on a long-term basis.

Muscle relaxants that act by diminishing the strength of muscle spasms locally include:

  • benzodiazepines
  • skeletal muscle relaxants
    • cyclobenzaprine (Flexeril)
    • orphenadrine
    • methocarbamol

Muscle relaxants that act on the central nervous system to lower spasticity include:

Effectiveness and precautions

There is debate about the effectiveness of muscle relaxants for back pain. A 2017 study Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source compared the addition of diazepam to naproxen to treat back pain and showed no benefit in comparison to naproxen and placebo.

Many of these medications have a high potential for abuse, so use them cautiously. They can decrease coordination and make you clumsy. Also, most of these medications have sedative effects, so don’t drive or operate machinery until you know how they will affect you.

Never mix muscle relaxants with recreational drugs or alcohol.

Learn which muscle relaxer is the strongest.

Opioids

Opioids are narcotic medications that act by depressing pain signals Trusted Source National Institute on Drug Abuse Governmental authority Go to source in the central nervous system. They do not treat the cause of the pain directly. Instead, they bind to receptors in the brain and spine.

Opioid medications include:

  • morphine
  • hydromorphone (Dilaudid)
  • oxycodone
  • meperidine (Demerol)
  • codeine
  • fentanyl
  • hydrocodone
  • oxymorphone

Precautions

Opioid medications are controlled substances and are highly regulated. This is because these medications may cause addiction. These medications are meant for short-term use only.

Also, because these medications depress central nervous system function, they can lower the respiratory drive. This can cause people to have low respiratory rates or stop breathing.

Other side effects include constipation, drowsiness, confusion, and depression.

If you take opioids, keep your medication secure and away from other people. Use it only as directed and only for as short a time as possible.

You should also keep a naloxone kit close by in case of accidental overdose. Naloxone is a medication that reverses the effects of opioids. The kit contains a nasal spray form of the medication that is easy to administer.

Weigh the benefits and side effects of opioids.

Oral steroids

Oral corticosteroids are medications that may lower inflammation in the body. Doctors commonly prescribe them for back pain, but studies suggest their effectiveness is limited. Oral steroid medications include:

  • prednisone
  • prednisolone
  • dexamethasone
  • hydrocortisone
  • methylprednisolone
  • cortisone acetate

Side effects

Oral steroids also have side effects, some of which may be serious Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source . These include:

Topical pain medications

Rubs, patches, and creams with a variety of active ingredients are available for back pain. These include:

  • menthol
  • capsaicin
  • CBD / cannabinoids (marijuana derivatives)
  • salicylates
  • NSAIDs
  • lidocaine
  • arnica

These medications may lower pain in muscle strains, muscle sprains, and arthritis. Some of them may be toxic in high amounts and may be absorbed through the skin. Apply them as directed and do not apply them to broken skin.

Other medications

Several other categories of medications can help treat back pain. These include:

  • disease-modifying antirheumatic drugs (DMARDs), which treat various types of arthritis
  • biologics and biosimilars, which stop inflammation at a particular part of the inflammatory process
  • osteoporosis medications, which slow bone loss or help the body build new bone

When to see a doctor for back pain

Contact your doctor for back pain that:

Learn more about when to see a doctor for back pain.

Summary

Back pain can be complex and hard to manage, but treatments are available. The right medication for you will depend on the cause of your pain, how long you have had the pain, and other medical conditions you may have.

Take all medications exactly as directed and do not share medications. Secure any opioid medications, preferably in a locked box. Tell your doctor about all medications and supplements you take.

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Medical Reviewer: Philip Ngo, PharmD
Last Review Date: 2023 Jan 31
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