This Is Why Pain Meds Aren't Helping Your Back Pain

A new study found that NSAIDs only worked for one in six people. Here's what you can do instead.

Rearview shot of an unrecognizable man holding his back in discomfort due to pain inside at home
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Back Pain Relievers for Different Types of Pain

If your go-to over-the-counter pain medicine hasn't been touching 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.1 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.1

Back pain relievers are usually designed to target only one type of back pain. For example, ibuprofen (Advil) is a non-steroidal anti-inflammatory drug (NSAID) that is effective at treating inflammatory back pain. It's often the first-line treatment recommended when you develop back pain. Unfortunately, most cases of back pain are not caused by inflammation.2

Causes of Back Pain

There are several possible reasons why your back has been aching. Inflammatory causes include ankylosing spondylitis and other types of arthritis in the spine.

A structural issue commonly causes both acute and chronic back pain. This occurs when there is injury or damage to the back. The damage may occur in the spine, spinal discs, muscles, tendons, or ligaments. Structural causes of back pain may include sprains, strains, aging discs, herniated discs, spondylolisthesis, spinal stenosis, and scoliosis.

Another common cause of back pain is neuropathic or nerve pain. According to a 2016 study in the European Journal of Pain, it's estimated that about 16% to 55% of individuals with chronic low back pain have possible neuropathic pain.3 Nerve pain usually feels like a sharp, burning sensation. It often shoots down the back into the hip, knee, or foot.

Other possible causes of chronic back pain include osteoporosis and fibromyalgia. Acute back pain may be caused by kidney strokes, endometriosis, infections, or tumors. Finally, pregnancy may lead to temporary back pain.4 Work with your healthcare provider to determine the cause and appropriate treatment plan.

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) treat inflammation in the body. Examples include ibuprofen (Advil) and naproxen (Aleve). While ibuprofen is usually recommended when you first develop back pain, it often doesn't help.

A 2017 meta-analysis in the Annals of the Rheumatic Diseases found that only one in six people taking NSAIDs for back pain experienced a significant improvement in their pain.2 This is because inflammation is not a common cause of back pain. Inflammatory causes of pain may include arthritis or age-related changes in or around the spine.

Most healthy adults can safely take NSAIDs for occasional pain but side effects are possible. This analysis found that people who took NSAIDs regularly were 2.5 times more likely to experience gastrointestinal problems like bleeding and stomach ulcers than those who did not use them.2

Acetaminophen

Acetaminophen, commonly known as Tylenol, is an over-the-counter (OTC) pain reliever and fever reducer. It is often recommended for chronic low back pain because it has a very low risk of side effects.

Acetaminophen can be taken with NSAIDs for inflammatory pain.5 It has also been found to reduce the need for opioid medications for severe back pain.1

Muscle Relaxants

Muscle relaxants are a type of pain reliever used to relieve back pain caused by muscle tension. They work by causing the muscles in the back to become less stiff. This can improve pain and allow for easier movement.6

Common muscle relaxants include carisoprodol (Soma) and cyclobenzaprine (Amrix). 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 nighttime 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.1

Antiseizure Medications

If you have been experiencing chronic neuropathic pain, your healthcare provider may recommend taking an antiseizure medication every day. Neuropathic pain in the back often causes shooting pain sensations down the hip or leg. Sciatica is an example of neuropathic back pain.

Antiseizure medications work by interrupting the pain signals being sent to the brain. They have also been found to effectively treat depression and anxiety as well. Examples of antiseizure medications used in chronic pain management include gabapentin (Neurontin) and pregabalin (Lyrica). Possible side effects include drowsiness, dizziness, and peripheral edema (swelling).5

Antidepressants

Another type of back pain reliever that is used to treat neuropathic pain is antidepressant medications. These drugs are often used to treat anxiety and depression. Like the antiseizure drugs, they are able to interrupt pain signals being sent to the brain.

Examples of tricyclic depressants that are used to treat chronic pain include amitriptyline and nortriptyline. They are helpful for treating chronic back pain when depression is also present. Examples of serotonin and norepinephrine reuptake inhibitors (SNRIs) include duloxetine (Cymbalta) and venlafaxine (Effexor).

SNRIs have been found to be more effective than selective serotonin reuptake inhibitors (SSRIs) at treating neuropathic pain. They are also helpful for depression and anxiety. Possible side effects include sleep disturbances and sexual dysfunction.5

Opioid Pain Relievers

Opioid pain medications may be used to treat severe, acute back pain. They are often prescribed after back surgery or to relieve pain from a new injury. They are not to be used long-term because they have a serious risk of dependence and abuse.1

A 2018 study in the Journal of the American Medical Association 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.7 Examples of common opioids include morphine, oxycodone, and hydrocodone.

Possible side effects of opioids include gastrointestinal distress, tolerance, and abuse.5 When used over a long period of time, opioids have been found to lead to poor pain outcomes, functional impairment, and a lower chance of being able to return to work.7

Topical Pain Relievers

Topical pain relievers come in the form of a cream, gel, or patch that can be applied directly to the skin on the back. They are used to treat neuropathic pain. If you have been unable to tolerate oral pain medications due to side effects, a topical one may be the right fit.

Two types of topical pain relievers used for back pain are capsaicin patches and lidocaine patches. Both of these patches can be used in conjunction with oral pain medications and have a low chance of side effects. Possible side effects may include a rash, swelling, or burning sensation. These patches should never be worn longer than 12 hours.5

Non-Medication Pain Relievers

In addition to medications, there are other techniques that you can try to ease your back pain. Non-medication pain relievers have a low risk of side effects and include:

If back pain has been affecting any area of your life, talk with your healthcare provider. The first step is to determine the underlying cause of your pain. From there, you and your provider will be able to choose the right type of treatment to target your individual back pain.

Common causes of back pain include age, injury, overuse, neuropathic causes, inflammation, and other health issues. Pain medications are designed to treat specific types of pain. If yours has not been working, talk with your provider about trying a new type of pain reliever.

Back pain is common but does not have to last forever. Make an appointment today to take the first step in figuring out the right back pain reliever for you.

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