Back pain can be a long-lasting source of discomfort for many people. Back pain can result from problems with the vertebrae or the spine's discs, as well as the nearby nerves and muscles. Although back surgery can be used to treat some causes of back pain, it is typically only used as a last resort. Most patients are able to control their back pain by using one or more kinds of medication.
NSAIDs
NSAIDs (non-steroidal anti-inflammatory drugs) are the most commonly used medications to treat back pain because of their mild side effects and wide availability (many NSAIDs can be purchased over-the-counter at drugstores). These medications relieve pain and also reduce inflammation, which can help with back pain caused by both muscle and nerve problems. Examples of NSAIDs include ibuprofen, aspirin and naproxen, as well as the prescription medication celecoxib. The most common side effects of NSAID use include slight impairment of blood clotting, gastrointestinal irritation (sometimes resulting in bleeding) and hypertension (as a result of fluid retention).
Narcotic Pain Relievers
Narcotic pain relievers are medications that are chemically related to opium. Some examples include codeine, hydrocodone, morphine and oxycodone. These powerful medications must be used with care because they can be habit-forming due to their effects on the brain and their ability to produce a feeling of euphoria. As a result, long-term use of narcotic pain relievers should be avoided if possible to prevent the patient from becoming tolerant of and dependent on the medication.
Steroid Medications
Steroid medications work by blocking the body's inflammatory response. This works well for back pain that is caused by swelling, which can lead to stiffness and pain as well as compression of the nerves. These prescription medications include prednisone, dexamethasone and methylprednisone, and can be taken orally or administered directly to the affected area via injection. Steroid medications have to be used carefully, however, because they can weaken the immune system as well as throw off the hormonal balance in the body with long-term use. As a result these medications should only be used under careful medical guidance and only in situations where the benefits outweigh the potential risks.
Muscle Relaxants
Sometimes back pain can be exacerbated by tightness in the surrounding muscles. The pain may originate in the muscles themselves or can be the result of them impinging and compressing nearby tissue (such as nerves). Short-term relief can be gained by using prescription muscle relaxants, which include diazepam (Valium), carisoprodol (Soma) and tizanidine (Xanaflex). These medications are not recommended for long-term use as they lose their effectiveness after approximately two weeks of regular use.
Nerve Blockers
Because the spine is designed to cushion and protect the spinal cord, sometimes back pain can be a result of problems with the nerves. This is caused by portions of the spine pinching or pressing on nerves. In these cases, the nerves can be blocked using an injection of a prescription anesthetic such as lidocaine or novacaine. Other options include the administration of creams or ointments (available with a prescription or over-the-counter) that contain capsaicin. Capsaicin is the ingredient that makes the "heat" that comes from spicy peppers; it can be applied to the skin to deplete the nearby tissue of a chemical called substance P. Substance P is used by the body to transmit pain signals. When substance P levels are depleted as a result of capsaicin cream usage, it makes that tissue unable to send pain signals to the brain. This brings pain relief.
Botox
If back pain is caused by muscle spasms that are not able to be controlled using muscle relaxants, injections of the botulinum toxin (Botox) can be used. The botulinum toxin works by temporarily blocking the connection between muscles and the nervous system, in effect temporarily paralyzing the muscles. Botox treatment, which is available only with a prescription, can be used specifically to target the muscles in the back. Botox treatment typically may take three to 10 days to be effective and can provide back spasm relief for up to four months.
