The Best Medications to Treat Back Pain

If your go-to over-the-counter (OTC) pain medication hasn't been helping your back pain lately, you're not alone. According to a 2018 review in American Family Physician, chronic low back pain affects up to 23% of adults worldwide. Back pain is a common problem for adults of all ages, and finding the right treatment can take time and a little trial and error.

Back pain may feel dull and achy, or sharp and pinching. It could be caused by an injury, age, inflammation, or other health condition. The most common causes of low back pain are repetitive trauma and overuse injuries.

Back pain relievers are usually designed to target only one type of back pain. For example, ibuprofen (Advil) is a nonsteroidal anti-inflammatory drug (NSAID) that’s effective for treating inflammatory back pain. It's often the first-line treatment recommended when you develop back pain. 

Here are a number of medications used to treat back pain. Some are available over the counter while others require a prescription from your doctor.

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation in the body. Examples include Advil (ibuprofen) and Aleve (naproxen). While ibuprofen is usually recommended when you first develop back pain, it may not be effective for all types of back pain. 

A 2020 review found that NSAIDs were only slightly more effective compared to placebo treatments for short-term back pain reduction. Because NSAIDs help lower inflammation, they may be more helpful for back pain caused by inflammatory conditions like arthritis.

Most healthy adults can safely take NSAIDs for occasional pain but side effects like stomach ulcers and kidney dysfunction are possible:

Acetaminophen

Tylenol (acetaminophen) is an OTC pain reliever and fever reducer. It’s often recommended for chronic low back pain because it has a low risk of side effects.

Acetaminophen may be more effective when taken with NSAIDs for back pain.

It has also been found to reduce the need for opioid medications for severe back pain.

Acetaminophen may cause side effects such as skin rashes, anemia, liver toxicity, and liver dysfunction.

Muscle Relaxants

Muscle relaxants are a type of pain reliever used to relieve back pain caused by muscle tension. They work by relaxing the muscles in the back, which can improve pain and allow for easier movement.

Common muscle relaxants include Flexeril (cyclobenzaprine), Zanaflex (tizanidine), and Glabofen (baclofen). 

Muscle relaxants cause all of the muscles in the body to relax and may cause drowsiness. It's best to try your first dose at night time to see how you feel. Muscle relaxants should only be taken for a short time because they carry a risk of dependence when used long-term.

Anti-seizure Medications

If you’ve been experiencing chronic neuropathic pain — a type of pain caused by damage to the nerves that carry information between your spinal cord and brain from other parts of your body — your healthcare provider may prescribe an anti-seizure medication. Neuropathic pain in the back often causes shooting pain sensations down the hip or leg. Sciatica is an example of neuropathic back pain.

Anti-seizure medications work by interrupting the pain signals being sent to the brain. Examples of anti-seizure medications used in chronic pain management include Neurontin (gabapentin) and Lyrica (pregabalin). Possible side effects include drowsiness, dizziness, and peripheral edema (swelling).

Antidepressants

Antidepressant medications are sometimes used to treat certain kinds of back pain. These drugs are commonly used to treat depression and anxiety, but low doses may help reduce back pain even when a person’s not feeling depressed. Like antiseizure drugs, they are able to interrupt pain signals being sent to the brain, which may help decrease back pain.

Examples of antidepressants that are used to treat chronic pain include Elavil (amitriptyline), Pamelor (nortriptyline), Cymbalta (duloxetine), and Effexor (venlafaxine).

Possible side effects related to antidepressant use include sleep disturbances and sexual dysfunction.

Opioid Pain Relievers

Opioid pain medications may be used to treat severe, acute back pain. They are sometimes  prescribed after back surgery or to relieve pain from a new injury. They’re not appropriate for long-term use because they’re highly addictive and carry a serious risk of dependence and abuse.

A 2018 study found that opioid medications were no more effective at treating chronic back pain than non-opioid medications. They also caused significantly more side effects than non-opioid pain medications.  

Examples of common opioids include morphine, oxycodone, and hydrocodone.

Possible side effects of opioids include gastrointestinal distress, tolerance, abuse, and depression.

When used over a long period of time, opioids have been found to lead to poor pain outcomes, difficulty completing activities of daily living, and a lower chance of being able to return to work.

If you think you may be dependent on opioids, contact a trusted healthcare provider right away.

Topical Pain Relievers

Topical pain relievers like creams, gels, and patches can be applied directly to the skin on the back. If you’re unable to tolerate oral pain medications due to side effects, your doctor may recommend a topical pain reliever to ease your symptoms. 

Two types of topical pain relievers used for back pain are capsaicin and lidocaine, which are available in creams and patches. Topical treatments used in conjunction with oral pain medications have a low risk of side effects. Topical back pain treatments may cause side effects like rashes, swelling, or a burning sensation. These patches should never be worn longer than 12 hours.

Non-Medication Pain Relievers

In addition to medications, there are other ways to ease your back pain. 

Studies show that the following may help ease some types of back pain:

• Physical activity
• Core strengthening
• Regular stretching
• Yoga
• Heat therapy 
• Ice packs
• Anti-inflammatory diet 
• Never smoking
• Maintaining a healthy weight
• Adequate sleep
• Cognitive-behavioral therapy
• Chiropractic care
• Acupuncture
• Spinal manipulation
• TENS unit (transcutaneous electrical nerve stimulation)

Causes of Back Pain

Back pain can result from inflammation, medical conditions that affect the spine, nerve pain, and more. 

Here are some of the most common causes of back pain:

• Injury or damage to the back or spine: Injuries or damage to the back muscles and spine like sprains, herniated discs, and spinal stenosis can cause your back to ache. Back surgery can also cause short-term back pain.
• Nerve pain: According to a 2016 study about 16% to 55% of individuals with chronic low back pain have possible nerve-related pain. Nerve pain usually feels sharp and can travel to the hip, knee, or foot.
• Medical conditions: Some medical conditions such as arthritis, osteoporosis, tumors, kidney infections, and fibromyalgia can cause back pain. 
• Pregnancy: Most people experience back pain during pregnancy. Hormonal changes, weight gain, and compression of the spine during pregnancy can lead to back pain.
• Obesity: Being overweight or obese is linked to a higher risk of back pain. Carrying extra weight puts pressure on your spine, which can cause your back to ache.

When to See a Healthcare Provider

If you’re experiencing chronic back pain or sudden, acute back pain, it’s important to talk with your healthcare provider.

Chronic back pain can be debilitating and impact your quality of life. Severe, sudden back pain could be a sign of a serious health condition like a kidney infection, that requires immediate medical attention. 

When treating back pain, the first step is to determine the underlying cause. From there, you and your provider will be able to choose the right type of treatment to target your individual back pain, which may include pain-relieving medication. Pharmacists, such as those at retail pharmacies, can also recommend over-the-counter medication.

Pain medications are designed to treat specific types of pain. If your current pain medicine isn’t helping your back pain, talk with your provider about trying a new type of medication.

A Quick Review

Back pain is a common condition that can be caused by injuries, medical conditions, pregnancy, and more. Back pain is commonly treated with pain-relieving medications, but it’s important to use the right kind. 

If you’re experiencing back pain that’s not responding to pain relievers, make an appointment with your doctor. They can recommend medications and other treatments that may be effective for your specific type of back pain.