From the Guidelines
For posterior thigh and lower back pain, I recommend starting with duloxetine, as it is associated with modest effects for chronic low back pain 1. Considering the evidence from the systematic review for an American College of Physicians clinical practice guideline 1, duloxetine is a viable option. The review found that several systemic medications for low back pain are associated with small to moderate, primarily short-term effects on pain.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may also be considered, but their effects are primarily short-term 1.
- Acetaminophen is no longer recommended as a first-line treatment due to its ineffectiveness for acute low back pain 1.
- It is essential to maintain gentle movement rather than complete bed rest and consider physical therapy for persistent pain.
- If symptoms worsen or don't improve within 1-2 weeks, consult a healthcare provider as prescription medications or further evaluation may be necessary. The primary goal is to reduce pain and improve quality of life, and duloxetine has shown promise in achieving this for patients with chronic low back pain 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medications for Posterior Thigh and Lower Back Pain
- The management of posterior thigh and lower back pain can be achieved through various medications, including:
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line treatment options for most patients with acute mild to moderate pain 2
- Topical NSAIDs for non-low back, musculoskeletal injuries 2
- Muscle relaxants for acute low back pain 2
- Tramadol, tapentadol, or acetaminophen/opioid or NSAID/opioid combinations for severe or refractory acute pain 2
- Ibuprofen has been shown to be consistently superior to paracetamol at conventional doses in a range of painful conditions, including acute post-operative pain, dysmenorrhoea, tension-type headache, migraine, osteoarthritis, and back pain 3
- Epidural injections with or without steroids have been found to be effective in managing lumbar radiculopathy or sciatica, with Level I or strong evidence for local anesthetic with steroids and Level II to I or moderate to strong evidence with local anesthetic alone 4
Considerations for Medication Use
- When using NSAIDs, caution should be exercised in patients with a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease 2
- Acetaminophen should be used with caution in patients with advanced hepatic disease, malnutrition, or severe alcohol use disorder 2
- Opioids should be used with caution and only for short-term use, due to the risk of addiction and other adverse effects 2