Your orthopedic surgeon or family doctor may prescribe medication for lower back pain to help manage related symptoms and discomfort. The most commonly prescribed medications include non-steroidal anti-inflammatory drugs, analgesics, and muscle relaxants, such as ibuprofen, acetaminophen or cyclobenzaprine. These can be prescribed for mild to moderate acute low back pain caused by poor posture or repetitive strain injuries.
For chronic lower back pain, your doctor may prescribe other options such as antidepressants or corticosteroid injections. These can help to reduce pain and inflammation and relieve symptoms related to a stiff back as well as difficulty sitting or walking.
The treatment of lower back pain should always be guided by an orthopedic surgeon, who can prescribe the best treatment approach, which may vary from patient to patient. Learn more about what causes lower back pain and what to do.
Medication options
Some medications that your doctor can prescribe for lower back pain include:
1. Analgesics
Analgesics like acetaminophen (Tylenol) can be prescribed by a doctor for mild to moderate lower back pain. They act by inhibiting the production of prostaglandins or cyclooxygenases, which are substances responsible for pain sensations.
These medications can be found in pharmacies, and although they are sold without a prescription, they should ideally only be taken as recommended by a doctor, as they are contraindicated for people with liver problems or impaired bone marrow function.
In some cases of severe back pain, the doctor may prescribe analgesics to be taken in combination with other drugs, such as muscle relaxants or opioids.
2. Non-steroidal anti-inflammatory drugs
Non-steroidal anti-inflammatory drugs, also known as NSAIDs, are usually the first treatment option for acute low back pain. Options include ibuprofen (Motrin, Advil), diclofenac (Cataflam, Voltaren) or naproxen (Aleve), and they act by reducing the production of inflammatory substances in the body, such as prostaglandins and thromboxanes to relieve lower back pain.
Non-steroidal anti-inflammatory drugs should be taken as directed by a doctor, as they are not indicated for certain situations, such as pregnancy, breastfeeding or by patients with a history of a stomach ulcer, gastritis, kidney disease, chickenpox or suspected dengue fever.
3. Muscle relaxants
Muscle relaxants, such as cyclobenzaprine (Flexeril or Amrix), can be prescribed by your doctor because they act by blocking nerve impulses or pain sensations that are sent to the brain and cause muscle contractions, spasms or pain. They work by promote muscle relaxation and relief from acute low back pain.
In some cases, muscle relaxants can be used in combination with other analgesics or NSAIDs to achieve pain relief.
Muscle relaxants should only be used by adults, for a maximum of 10 days to 3 weeks, as directed by your doctor.
4. Benzodiazepines
Benzodiazepines, such as diazepam, can be indicated to reduce muscle spasms or contractions. This can help relieve acute lower back pain caused by injuries to the back muscles.
These drugs can only be obtained with a doctor's prescription and should only be used for a short period of time, as they can cause side effects such as dizziness, drowsiness or addiction.
5. Opioids
Opioids such as tramadol (Tramal) or codeine are more powerful analgesics that are prescribed by the doctor in cases of of very intense lower back pain that does not improve with common analgesics. These should only be used for a short period of time.
There are also opioid medication, like codeine, that are compounded with acetaminophen. These should be used as directed by your doctor.
Opioids are not indicated for the treatment of chronic lower back pain.
6. Antidepressants
In some cases, the doctor may prescribe certain types of low-dose antidepressants, such as amitriptyline or nortriptyline. These can help to relieve certain types of chronic low back pain.
Antidepressants should only be used as prescribed by a doctor.
7. Dressings and ointments
Impregnated dressings and ointments with analgesic and anti-inflammatory action, such as Emulgel or Voltaren gel, can also help to relieve pain. However, they are not as effective as systemic medication. They are a good option in cases of mild pain or as a complement to systemic treatment.
8. Injections
When back pain is very intense and there are signs of sciatic nerve compression such as pain and burning, difficulty sitting or walking, when it feels like the spine is locked, the doctor may prescribe anti-inflammatories and muscle relaxants in the form of injections.
In some cases, such as when treatment is not effective enough to reduce pain or when the pain radiates down the leg, the doctor may recommend corticosteroid injections, using betamethasone dipropionate and betamethasone disodium phosphate. These can help to fight inflammation and relieve symptoms quickly.
Other ways to manage lower back pain
Some alternative methods that can be combined with pharmacological treatment to manage lower back pain are:
- Physiotherapy, which involves exercises prescribed by a physiotherapist. These exercises may differ from person to person.
- Warm compresses on the painful area or electrotherapy sessions, which heat up the affected area. This can be useful for reducing inflammation in the area and eliminating pain;
- Postural correction exercises, which can be introduced after pain is relieved. These help to prevent symptom flare-up and also strengthen the muscles of the spine. Clinical Pilates and RPG are appropriate for lower back pain management, as they bring relief from symptoms within a few weeks, although full treatment can take around 6 months to 1 year.
- Lower back stretches, which help to relieve pain and increase range of movement. Check out some lower back stretches that you can use to relieve pain.
Spinal surgery may be indicated for cases of a herniated disc or spondylolisthesis, however your doctor will likely explore other treatment approaches first.
