Back and Neck Pain Medications Used From Mild To Severe Pain Relief
Judicious use of mild forms of medications for neck & back pain can help with reducing pain and inflammation when used as prescribed or recommended. Although these medications can’t stop the progression of degenerative conditions like osteoarthritis, they can help with control of the pain.
Back and neck pain medications containing aspirin are available as over the counter pain relievers that usually help alleviate mild levels of pain associated with neck & back pain. Side effects associated with aspirin can be stomach problems like ulcers, sometimes with bleeding. Do not take aspirin products during pregnancy. If you are pregnant, you should consult with your obstetrician about ANY medications you take.
- Non Steroid Anti Inflammatory Drugs (NSAIDs)
Back and neck pain medications like naproxen and ibuprofen are pain relievers that can be obtained over the counter. Previously only obtained by prescription, they are now readily available and can be effective for relief of pain due to inflammation of osteoarthritis and minor strains of muscles associated with neck & back pain, reducing joint inflammation. If you have any kidney problems, you should not take these NSAIDs, and overuse can lead to kidney problems.
A 2021 study in Academic Emergency Medicine compared 3 NSAIDs for acute low back pain. After 5 days the results were: ibuprofen 9.4, ketorolac 11.9, diclofenac 10.9. Mild or no pain at day 5 was: ibuprofen 38/61 (62%); ketorolac 47/59 (80%); diclofenac 45/62 (71%) Stomach irritation was reported by 16/62 (26%) ibuprofen patients, versus 3/61 (5%) for ketorolac, and 6/64 (9%) for diclofenac.
Ketorolac is for short term relief of moderate-severe pain and should not be used for more than 5 days, for mild pain, or for pain from chronic conditions. The first dose of ketorolac is by intravenous or intramuscular injection. After that, your doctor may choose to continue with oral ketorolac, however, you must stop taking oral ketorolac on the fifth day after your first injection.
A 2021 study in the Medical Journal of Austrailia found elevation of blood liver enzyme levels was more frequent during repeated administration of tylenol for spinal pain and that it was not effective for reducing acute low back pain.
- Non Narcotics
Analgesics is the term used for pain relievers that treat pain at the injury point and are used for pain ranging from mild to moderate. Popular over the counter analgesics are Tylenol and aspirin. For any analgesic that provides more pain relief than over the counter preparations, a prescription from a doctor is required, Typical NSAIDs requiring a prescription are: sulindac, ketoprofen, fenoprofen, and carprofen. Prescription analgesics usually pose the risk of increased side effects. With these, it is advisable to refrain from lying down 15-30 minutes after consumption. They can also increase susceptibility to sunlight, so wear appropriate protective clothing, use sun blockers and try to stay away from direct sunlight. Avoid use with chronic ulcer and liver problems.
With more severe levels of pain, your doctor may prescribe the use of narcotic medications for pain like morphine or codeine. Narcotics medications provide relief of pain through actions on the relieve pain by acting on the central nervous system as an anesthetic. Narcotics pain medications may cause drowsiness, sedation, vomiting and nausea, so you should be aware of these potential side effects. To reduce the risk of these side effects, try to avoid the use of antidepressants or sleeping medications and alchohol.
Morphine & codeine are opioids, derived from the poppy plant. Additional opiods commonly used for severe pain are: Dilaudid (hydromorphone), Demerol (meperidine), Duragesic (fentanyl), Percodan (oxycodone with aspirin), Percocet (oxycodone with acetaminophen), methadone, and Vicodin (hydrocodone).
To help avoid constipation that often accompanies taking narcotic back and neck pain medications, eat sufficient amounts of natural fiber – not bulking agent pills which can make things worse, keep hydrated, and use a stool softener and laxative when necessary should you become constipated. In fact, it may be a good idea to start using these before you become constipated. Stool softeners such as (Colace) docusate and laxatives like Dulcolax (bisacodyl, senna) are usually suggested. Should these not work, Miralax, Milk of Magnesia, or or magnesium citrate may help.
Remember, narcotics can become quite addicting.
However, it is evident that the CDC well overestimated deaths related to prescription opioids. This had prompted reference to an “epidemic” or “crisis”. As a result, states were given money to combat the manufactured epidemic. Laws were changed. Now, you must see a pain management doctor or specialist to get a prescription. The confession by the CDC came out after taxpayer money was allocated and rules changed. They indicate the figures were overestimated by over 50%. Mistake?
The authors of the above referenced article in a 2017 edition of the Journal of Pain Research stated, “The concern is this: for the CDC to suggest that more than 15,000 died in that year from “prescription opioids” when a closer examination of the data indicates that illicit opioids and/or polypharmacy were involved is not only inaccurate and disingenuous, it can negatively impact patients who are well-managed on long-term opioid therapies and have no effective safe alternatives that are covered by insurance, negatively impact health care providers who seek to relieve suffering, and negatively impact people who are suffering from substance use disorders.”
- Muscle Relaxants
If you are experiencing muscle spasms, prescription muscle relaxants may be prescribed. While they can help ease pain associated with muscular spasm, they are not particularly effective for many individuals, and can cause depression and drowsiness, therefore, they are not an effective long term strategy. Use marginally or perhaps about a week.
Sometimes, combining types may be appropriate. A 2020 study in Drug, Healthcare and Patient Safety found that Eperisone Hydrochloride, a centrally acting muscle relaxant, 50 mg 3 times a day combined with ibuprofen (NSAID) 400 mg twice daily for 4 weeks effectively reduced pain and improved functional outcomes compared with ibuprofen alone in patients with acute non-specific back pain with muscle spasm.
The use of fixed drug combinations facilitates clinical practice and increases patient adherence, often offering better treatment results. A 2021 study found diclofenac (NSAID) 75 mg and orphenadrine (Muscle relaxant) 30 mg was effective for relief of acute back musculoskeletal pain syndrome.
Neck and back pain is often associated with symptoms of depression and antidepressant drugs may assist with in alleviating some of the emotional stress that can cause or aggravate neck and back pain. There is an association in nerve pathways between depression and pain and the chemicals produced. Depression can lead to pain and pain can lead to depression. This can turn into a vicious cycle. There are antidepressants that appear to alleviate some back and neck pain, possibly affecting the nerve – chemical pathways and they may offer some relief from insomnia. Some common symptoms of antidepressant medications are fatigue, dry mouth, constipation, decreased appetite and drowsiness.
Many individuals suffering mild to moderate levels of pain will use natural pain relievers such as supplements and/or topicals to avoid some of the common side effects of commonly prescribed back and neck pain medications. Just because they are natural, it does not mean they will not interact with over the counter or prescription medications. So, when taking medications for back and neck pain, follow the instructions of your doctor and read the information that comes with the medications. If you have questions, always consult your doctor or pharmacist.
A 2020 study in the Fukushima Journal of Medical Science found, when combined with exercise, duloxetine resulted in improvement of low back pain related disability in 52% of patients. There was also a reduction in anxiety associated with the improved disability.
Duloxetine is an anti-depressant and nerve pain medication used in treating anxiety, diabetic peripheral neuropathy, fibromyalgia, and chronic muscle or bone pain. Brand names are Irenka and Cymbalta.
A 2021 study in the International Journal of Clinical Pharmacy found that ibuprofen plus tylenol combination resulted was significantly more effective in preventing pain persistence for neck and back pain. A previous Cochrane Database System of Reviews found that ibuprofen 200 mg + tylenol 500 mg led to 7.6 hours before re-medication compared to placebo at 1.7 hours for acute postoperative pain.
A 2021 study in the European Journal of Pain found that type 2 diabetes patients taking metformin (Glucophage, Riomet, Glumetza) reported fewer back and neck/shoulder complaints. The authors concluded, “Therefore, when treating these patients, clinicians should be aware that metformin may contribute to fewer reports of musculoskeletal pain.”
A 2022 study in Clinical Neurology and Neurosurgery found the addition of Pentoxifylline to the treatment of lumbar disc hernia with radicular pain significantly decreases pain intensity in addition to improving treatment satisfaction. Pentoxifylline is an anti-inflammatory and vasodilator used to treat poor blood circulation by improving the flow of blood through the vessels. It can reduce leg pain caused by poor blood circulation.