From the Guidelines
For patients with lower back pain, clinicians and patients should select nonpharmacologic treatment with superficial heat, massage, acupuncture, or spinal manipulation, and if pharmacologic treatment is desired, nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants should be chosen. According to the American College of Physicians guideline 1, nonpharmacologic treatments are recommended as the first line of treatment for acute, subacute, and chronic low back pain. When considering pharmacologic treatment, nonsteroidal anti-inflammatory drugs should be selected as first-line therapy, with tramadol or duloxetine as second-line therapy for patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy 1. Some key points to consider when treating lower back pain include:
- Nonpharmacologic treatments such as exercise, multidisciplinary rehabilitation, acupuncture, and mindfulness-based stress reduction are recommended for patients with chronic low back pain 1
- Opioids should only be considered as an option in patients who have failed other treatments and only if the potential benefits outweigh the risks for individual patients 1
- Medication use should be limited to 7-10 days unless directed otherwise by a healthcare provider
- Complementing medication with gentle stretching, applying heat or ice, and maintaining good posture can also help alleviate lower back pain. It is essential to note that if pain persists beyond two weeks, worsens, includes numbness/tingling, or affects bladder/bowel function, medical attention should be sought immediately as these could indicate a more serious condition requiring different treatment.
From the Research
Lower Back Pain Medication Options
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to treat lower back pain, with studies showing they can provide short-term pain reduction and improvement in disability 2.
- Acetaminophen is also recommended for acute low back pain, although its effectiveness compared to NSAIDs is not well established 3.
- Muscle relaxants, such as cyclobenzaprine, and opioids, such as oxycodone, may be prescribed for acute low back pain, but their effectiveness is not well supported by evidence 4, 5.
- Topical treatments, such as heat wraps and rubefacients, may provide immediate pain relief, but their long-term effectiveness is unknown 6.
Effectiveness of Different Medications
- A study comparing naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo found no significant difference in functional outcomes or pain at 1-week follow-up 4.
- A systematic review of NSAIDs for acute low back pain found moderate-quality evidence that they are slightly more effective than placebo for short-term pain reduction and disability improvement 2.
- A review of over-the-counter treatments for chronic low back pain found that NSAIDs, acetaminophen, and antidepressants may be effective, but the evidence is limited 5.
Treatment Guidelines
- The American College of Physicians recommends that patients with acute low back pain be advised to stay active, avoid bed rest, and return to work early, and that NSAIDs or acetaminophen be considered if medication is necessary 3.
- Imaging studies, such as x-rays or MRI, are not usually required for acute low back pain, but may be considered if symptoms persist or worsen over time 3.