Different types of medication can be used to help reduce the symptoms associated with spine problems. They include over-the-counter and prescription medications.
There are several over-the-counter painkillers that can help reduce back and neck pain.
Paracetamol is the most widely used painkiller. It’s available in standard and slow release options. The slow release preparation works for 6 to 8 hours versus 4 to 6 hours for the standard preparation. Paracetamol is usually safe when taken as directed but if you exceed the recommended dose it can be toxic to your liver. While doctors often recommend paracetamol because of its relative safety, its effectiveness in back pain is fairly limited. If you’ve already tried paracetamol and you still have back pain, it may be time to look for other medication options.
Some non-steroidal anti-inflammatory agents (NSAIDs) — pronounced ‘en-seds’ — are available from your pharmacy or supermarket. Aspirin, ibuprofen, diclofenac and naproxen are common NSAID medications. They relieve both pain and inflammation. Inflammation may be one of the things that makes your back feel stiff. NSAIDs tend to cause gastric side effects so you must take them after food. Kidney problems can also occur and some people with breathing difficulties can be adversely affected. Consult your doctor before trying them if you have any other health conditions.
Some newer NSAIDs such as meloxicam are only available on prescription. You may have to try more than one NSAID before you find one that works for you.
You can take both paracetamol and an NSAID together, as they work on different pain pathways. You can now get combination preparations which contain both paracetamol and an NSAID. You can also take them separately. The combination of two ingredients can give you extra relief.
Both paracetamol and NSAIDs are also available in combination with codeine. Codeine is an opioid analgesic which blocks pain receptors in the brain. It can cause side effects such as constipation and/or drowsiness in some people. It can also be habit-forming if you take it regularly. There’s not much evidence that codeine helps with back pain. Medicines containing codeine are only available by prescription as of 1 February 2018.
Paracetamol is also available in combination with caffeine which may enhance the pain relieving effect of the paracetamol. Caffeine can cause side effects such as fast heartbeat, anxiety and sleeplessness in some people. Studies have also shown an enhanced effect when an NSAID is taken in combination with caffeine.
Topical NSAID gels
You can rub an NSAID gel containing ibuprofen or diclofenac over the painful area. It’s absorbed through the skin and can provide relief of pain and inflammation with less risk of gastric side effects, compared to an NSAID tablet or capsule. You shouldn’t use an NSAID gel if you’re also taking an NSAID tablet or capsule.
Ointments containing methyl salicylate, capsaicin, camphor, menthol or eucalyptus oil can help relieve pain by stimulating the nerves near the painful area and interrupting pain signals. Herbal liniments often contain these same ingredients, plus herbs as well.
Researchers have found several herbal medicines that may be effective in reducing lower back pain in the short term. They are devil's claw, turmeric, white willow bark, cayenne, comfrey, Brazilian arnica and lavender essential oil. However, their conclusions are based on limited trials, and additional research is needed to determine their safety and effectiveness for long-term use. Some herbal medicines can react with other drugs, so be sure to let your doctor know what you’re taking.
Note: If you’re using medications for your back pain every day, it’s time to see your doctor. Chronic use of some medications can have adverse effects.
Oral prescription medications
Your GP can prescribe a range of medications for your back pain. These may include stronger NSAIDs such as meloxicam, celecoxib, mefenamic acid, diclofenac, piroxicam and ketoprofen. Some of these can give 24 hours’ relief with one dose.
For flare-ups of pain, your doctor may also recommend short-term use of more powerful painkillers containing opioids such as codeine, oxycodone, morphine, buprenorphine, fentanyl, tramadol or tapentadol. Some are available as oral medications and others as patches. They’re only suitable for short-term use because of their side effects, toxicity and potential for addiction.
If muscle spasm is a factor, your doctor may prescribe a muscle relaxant such as diazepam. These can provide added relief but may cause dizziness and drowsiness. They’re only suitable for short-term use.
You need to be very careful driving if you’re taking an opioid or muscle relaxant medication.
Anticonvulsants (drugs used for treating epilepsy) such as pregabalin (Lyrica®) or gabapentin (Neurontin®) are also used by some doctors to treat chronic back pain, particularly where nerve pain is thought to be involved. These drugs can also cause drowsiness.
Amitriptyline, a drug also used for treating depression, can be effective in relieving chronic back pain and insomnia. Sedation, dizziness and dry mouth are common side effects.
Chat with your doctor about the risks and benefits associated with any prescription medicine, and whether it’s right for you.
Injectable prescription medication
Your doctor may recommend a corticosteroid injected next to your spine to provide temporary, and at times permanent, relief of back pain. It’s possible this will give you relief that lasts long enough for you to start a program of physiotherapy to strengthen and mobilise your back.
Your GP may refer you to a radiologist where you can have a CT-guided steroid injection. There are many different types of CT-guided steroid injections, so your GP will need to advise you. Sometimes your GP will refer you to a specialist to choose the best one. The injection sometimes causes side effects, and can take up to a week to have its maximum effect. So you may need to schedule some time off work or have the injection before a weekend break.