From the Guidelines
The most effective medications for treating back pain are nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) at 400-800mg every 6-8 hours (maximum 3200mg daily) or naproxen (Aleve) at 220-500mg every 8-12 hours (maximum 1500mg daily), as they provide the best balance of benefits and risks for most patients 1. When considering treatment options for back pain, it's essential to weigh the benefits and risks of different medications.
- NSAIDs, such as ibuprofen and naproxen, are effective for reducing inflammation and pain, but they can cause stomach irritation, kidney problems, and increased cardiovascular risk with prolonged use 1.
- Acetaminophen (Tylenol) is a slightly weaker analgesic than NSAIDs but has a more favorable safety profile and low cost, making it a reasonable first-line option for treatment of acute or chronic low back pain 1.
- Muscle relaxants, such as cyclobenzaprine, may be recommended for more severe pain, but they can cause drowsiness and have a higher risk of abuse and addiction 1. It's crucial to use these medications at the lowest effective dose for the shortest duration possible and to combine them with non-drug approaches like physical therapy, gentle exercise, proper posture, and heat or cold therapy to achieve the best results for back pain management 1. Key considerations when choosing medications for back pain include the presence of risk factors for complications, concomitant medication use, baseline severity of pain, duration of low back symptoms, and costs 1. Ultimately, the decision to use a particular medication should be based on a thorough discussion of potential benefits and harms with the patient, taking into account their individual needs and preferences 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medications for Back Pain
The following medications are commonly used to treat back pain:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac 2
- Acetaminophen 3
- Gabapentin and pregabalin for neuropathic pain 4, 5
- Tramadol 6, 5
- Opioids, although their use is typically avoided in older adults due to the risk of morbidity and mortality 5
- Antispastic and antispasmodic muscle relaxants 5
- Tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for neuropathic pain 5
Efficacy of Medications
Studies have shown that:
- NSAIDs are more effective than placebo in reducing pain intensity and disability in patients with chronic low back pain 2
- Gabapentin and pregabalin have mixed evidence for neuropathic pain, with some studies showing benefit and others showing no significant improvement 4, 5
- Tramadol has some evidence for efficacy in older patients, but more so in persons aged < 65 years 5
- SNRIs have good evidence for neuropathic pain and a more favorable safety profile than TCAs 5
Safety and Adverse Effects
The use of these medications can be associated with adverse effects, including:
- Gastrointestinal and renal risk factors with NSAIDs 2, 5
- Cognitive and classic opioid side effects with tramadol 5
- Increased risk of morbidity and mortality with opioids in older adults 5
- Adverse events such as dizziness, fatigue, difficulties with mentation, and visual disturbances with gabapentinoids 4