From the Research
For severe degenerative disc disease (DDD) at L5-S1, a comprehensive medication approach typically begins with over-the-counter NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation and pain. If these provide insufficient relief, prescription NSAIDs such as meloxicam (7.5-15mg daily) or celecoxib (100-200mg twice daily) may be more effective, as suggested by various studies 1, 2. Muscle relaxants like cyclobenzaprine (5-10mg three times daily) or tizanidine (2-4mg every 6-8 hours) can help with associated muscle spasms for short-term use (1-2 weeks). For more severe pain, tramadol (50-100mg every 4-6 hours) might be prescribed briefly, though opioids should generally be avoided due to dependency risks, as noted in the management of chronic low back pain 2. Gabapentin (300-600mg three times daily) or pregabalin (75-150mg twice daily) may help if there's nerve involvement, with a study from 2022 indicating that both pregabalin and gabapentin can be equally effective in reducing pain in lumbar radiculopathy patients who underwent transforaminal epidural steroid injection 3. These medications work by reducing inflammation at the disc site, relaxing tense muscles that compensate for the damaged disc, and modulating pain signals. Combining medication with physical therapy, proper posture, and core-strengthening exercises is essential for long-term management, as medications alone cannot reverse the disc degeneration, and a multidisciplinary approach to treatment is often warranted 4, 2. Key considerations include patient education, cognitive behavioral therapies, and the potential for surgical intervention with a rehabilitation regime in some cases, with prognostic factors related to the outcome of different treatments including maladaptive pain coping and genetics 2.