Back Medications

000802_c373_0013_cslsWhen it comes to designing a plan of care for patients experiencing back pain — whether with back pain medications(drug therapy), physical therapy or any other methods of care — all back pain management plan must be individualized, or in other words, you just cannot plan to treat every single back pain in the same manner, because not all back pain are of the same type, origin, or magnitude.

Remember, back pain can be specific, non-specific, referred, chronic, acute, and so on. Thus, plan of care should be designed to fit each patient’s needs, or, based on the type or severity of back pain the individual is currently experiencing.

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For example, although most health care providers believe anti-inflammatory drugs may be enough to control the pain most patients often experience during an acute episode of back pain, however, they often suggest bed rest, (although recent studies suggest that for most patients, continuing daily activities as tolerated, is more effective as opposed to bed rest)analgesia, and patient’s education as the key elements of most conservative treatments for acute back pain. Patients with severe pain however, may be prescribed opiates, but rarely does the need for opiates extend beyond 1-2 weeks.

Since drug therapy is one of the key elements in treating chronic or acute back pain, my primary goal here, is to focus primarily on some of the common back pain medications that are often used, and their effects.

Pharmacologic Approach

Pharmacologic intervention is common for reducing the symptoms of low back pain and for maintaining function. Whenever drugs therapy is deemed necessary for the treatment of back pain, the drugs often used may be nonprescription or prescription, oral, topical or injected.

Going back to those three college semesters I spent studying pharmacology, from what I have learned, some types of pharmaceutical agents used in the treatment of low back pain are the following:

Anti-inflammatory drugs (NSAIDS), and steriods)

  • Muscle relaxants
  • Angalesics (opoid and nonopioid)
  • Antidepressants
  • Anticonvulsants
  • Anesthetics

However, it’s important to know that although these medications may be useful in assisting back pain sufferers in tolerating the pain, none of them, or no medications in general are designed to cure low back pain.

Commonly used Nonprescription Medications

  • Acetaminophen (Tylenol)
  • Aspirin
  • Aleve
  • Ibuprofen (Motrin and Advil)

Tylenol is believed to be a simple analgesic with strong evidence for effectiveness in relieving the symptoms of low back pain and promoting activity and participation. The others are considered anti-inflammatory analgesics(NSAIDs)

Non-Steroidal Anti-inflammatory Drugs (NSAIDs) are widely prescribed for acute and chronic low back pain, and are believed to be useful in reducing swelling and inflammation and promoting healing, due to their strong anti-inflammatroy properties.

Examples of prescription NSAIDs

  • Dolobid
  • Naprosyn
  • Relafen
  • Ansaid
  • Voltaren
  • Celebrex(Cox-2 inhibitor)

NSAIDs Side Effects

NSAIDs, athough very useful, are believed to have a number of potentially serious side effects, especially gastrointestinal tract irritation and renal effects. Cox2-inhibitors have been associated with risk of stroke and myocardial infarction(Heart Attack). Thus patient should not be kept on them for long. It’s advised that both prescription and nonprescription NSAIDs should be used with discretion.

It’s believed that even the use of over-the-counter NSAIDs, are sometimes contraindicated with acetaminophen and a muscle relaxant(eg. Flexeril, soma, Valium) to relieve muscle spasms in acute low back pain.

Muscles Relaxants Side Effects

Based on one text, some muscle relaxants such as diazepam, cyclobenzaprine, carisoprodol, and methocarbamol should be limited to courses of 1-2 wks, and should not be given to older pts who are at risk for falling. Drowsiness is known to be a common side effect of muscle relaxants.(Stobo et al p264)

Opioids Side Effects

Although opioids have a broad range of effects, their primary use is to relieve intense pain and the anxiety that accompanies it. However, their widespread availability has led to abuse of those opioids with euphoric properties. Euphoria is defined as a sense of contentment and well-being. Any drug that has Euphoric properties has the ability to produce a powerful sense of contentment and well-being(Mycek et al)

Steroids
Oral steroids (eg., Prednisone, Medrol) are occasionally used over a short period (short term 1-2 weeks) for more severe inflammation.

Injection
Injection therapy such as epidural injections and nerve blocks are also used to treat severe
back pain.

Note:This brief pharmacological approach to treating back pain is only for general education purpose. Readers are therefore advised to always consult with a pharmacist or their healthcare providers before initiating or considering any of the above drugs therapy for their back pain.

sources:
 1.Mycek J. Mary et al; Lippincott's Illustrated Reviews:2nd Ed
 2.Stobo et al;The Principles of Medicnie: 23rd Ed
 3.American College of Sports Medicine's Resources for Clinical Exercise Physiology:2nd Ed

Comments or questions are welcome.

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