Prescription Pain Relievers - Conservative Measures: Back Pain

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Prescription pain relievers

If your low back pain is severe (as is often the case in nerve compression syndromes), or if it becomes chronic, your doctor may prescribe stronger medications. Following are descriptions of those most often prescribed.

COX-2 inhibitors

These medications, which include celecoxib (Celebrex), rofecoxib (Vioxx), and valdecoxib (Bextra), are no more potent than the standard NSAIDs, but they became best sellers because they offered pain relief with less risk of developing the unwelcome gastrointestinal side effects that could accompany the long-term use of standard NSAIDs. As such, they have sometimes been prescribed for people with chronic low back pain.

Unfortunately, studies have confirmed a link between taking COX-2 inhibitors and increased risk of developing heart disease and stroke. In light of the evidence, experts at the FDA and elsewhere are rethinking when and how these drugs should be used — and by whom.

In September 2004, the manufacturer of Vioxx voluntarily removed the medication from the marketplace, although it is possible it may return with a warning label. Then, in April 2005, the FDA ordered that Bextra be taken off the market. Celebrex is still available. Also in 2005, the FDA contacted manufacturers of all NSAIDs — both prescription and over the counter — requesting that they make labeling changes on their products to alert consumers to the potential increased risk of cardiovascular events. In the case of Celebrex, the FDA may take further regulatory action after analyzing the preliminary reports from one of several long-term studies conducted by the National Institutes of Health.

While COX-2 inhibitors benefit a subset of people with chronic back pain, they are not recommended for people suffering from garden-variety acute back pain, which can be managed with less risky over-the-counter medications. If you are considering taking a COX-2 inhibitor, talk with your physician about the risks and benefits as they apply to you.

Muscle relaxants

Muscle relaxants are no better than standard NSAIDs for treating the symptoms of most acute low back pain. However, a short course of muscle relaxants, taken as prescribed by a physician, can be useful for people who have severe muscle spasms following the onset of low back pain. Other options are diazepam (Valium), which has muscle-relaxing properties, or cyclobenzaprine (Flexeril), although you should discuss the risks and benefits of these medications with your doctor.

Other options

If your pain is intense and has not responded to other medications, your doctor may give you a prescription for acetaminophen with codeine for a limited period. If you are suffering from a compression fracture, where the pain is very severe, your doctor may prescribe an opiate such as oxycodone (Percodan) or hydrocodone (Vicodin).

Antidepressants are sometimes prescribed for chronic, ongoing back pain, especially when it is nerve pain. A number of studies reviewed in Spine in 2003 supported the idea that the off-label use of tricyclic and tetracyclic antidepressants helps some people with chronic low back pain.

Medications typically used for neuropathy (a form of nerve pain) may also be helpful in treating low back pain. One example is gabapentin (Neurontin), a drug originally developed to treat epilepsy. Studies have shown that gabapentin is effective at treating neuropathy; this medication may provide another option for back pain.

Last updated:	January 23, 2007