Common Medications for Lower Back Pain Relief

Medically reviewed by Erika Prouty, PharmD

Lower back pain can affect one's ability to move comfortably and function throughout the day. Medications, including over-the-counter (OTC) and prescription drugs, are available to manage pain and provide relief.

However, what medication you use depends on factors such as how bad the pain is, how long it's been there, and why it's happening. Pain can be acute (lasting less than one month), chronic (lasting more than three months), or subacute (lasting somewhere between one to three months). The type of lower back pain you're experiencing may affect your treatment.

This article will discuss common medication options for lower back pain relief.

Over-the-Counter Medications for Lower Back Pain

You may choose OTC medicines to help with lower back pain, especially if the pain feels mild to moderate. They're also suitable for short-term use and are cheaper and easier to pick up since there’s no healthcare visit required. You can buy them at most stores without a prescription.

OTC medicines include certain drugs like nonsteroidal anti-inflammatory drugs (NSAIDs) and Tylenol (acetaminophen). Examples of OTC NSAIDs are Advil or Motrin (ibuprofen) and Aleve (naproxen sodium).

Topical Medications for Low Back Pain

Topical medications are also available for pain relief. These products come in gels, creams, and patches applied to the skin. Topical medications can also often be used with oral medications.

Examples of topical pain relief medications include:

• Menthol

• Menthol, methyl salicylate, and camphor

• Lidocaine

• Voltaren Arthritis Pain (diclofenac)

Tylenol (Acetaminophen)

Tylenol, also called acetaminophen, is a common medicine for pain relief. It is taken by mouth every four to six hours and can help relieve minor pain and reduce fever.

Tylenol isn't an opioid—it's a different kind of pain reliever. It can be beneficial for managing acute pain because it has few side effects.

Tylenol helps with pain by stopping the body from making certain chemicals that cause pain and fever. By doing this, Tylenol makes pain and fever go down. It also works in the brain.

You can use Tylenol for headaches, muscle aches, toothaches, backaches, and cramps during periods. It's also used for joint pain in the hands or knees (osteoarthritis) and rheumatoid arthritis. And it's often used to lower fevers in adults and children.

Tylenol is usually safe, but it's important to know about possible side effects, such as:

• Feeling nauseous or vomiting

• Painful or difficult bowel movement

• Rash or blisters

• Allergic reactions

• Liver damage

Always follow the right dose and talk to your healthcare provider if something doesn't feel right. For adults without liver problems, the package insert recommends no more than 10 tablets (3,250 milligrams) a day.

If you have had liver problems or drank excessive amounts of alcohol in the past, you should be careful using Tylenol because it might stress your liver more. Avoid using Tylenol for a long time without talking to your healthcare provider. Your provider may also recommend a lower maximum daily dose.

Nonsteroidal Anti-Inflammatory Drugs

Safety Considerations with NSAIDs

NSAIDs can heighten the risk for severe and potentially life-threatening heart problems, like heart attack or stroke. This risk is increased with higher doses and longer durations of use. If you have a history of heart problems, NSAIDs may not be the right choice for you.

NSAIDs can also cause ulcers or bleeding in the stomach or intestines. This risk is higher for people who are older, smoke, or drink large amounts of alcohol.

Stop taking your medication if you have severe stomach pain, heartburn, vomit that is bloody or looks like coffee grounds, or bloody, black, or tarry stools.

Nonsteroidal anti-inflammatory drugs, also called NSAIDs, are medications that many people use to ease pain, often related to arthritis, headaches, cramps, and muscle aches. This means they could be a suitable option if you're experiencing lower back pain. NSAIDs come in different forms, like tablets, creams, and gels.

NSAID medicines work by lowering swelling and relieving inflammation. Some examples are Advil, Motrin (ibuprofen), Aleve (naproxen), and Bayer (aspirin). They all help by stopping the body from making certain compounds that cause pain and swelling.

Even though NSAIDs are usually safe, there can be side effects and issues, such as:

• Upset stomach

• Heartburn

• Kidney problems

People with a history of stomach bleeding, kidney problems, or heart issues should talk to their healthcare provider before taking NSAIDs.

Prescription Pain Medications for Lower Back Pain

While OTC relievers may help with mild or moderate pain, more severe pain might require stronger medications that your healthcare provider can prescribe. You might need a prescription-strength medication if you have severe or long-lasting lower back pain or if there are other medical issues involved, like cancer or nerve pain.

For example, healthcare providers might prescribe opioids like oxycodone or muscle relaxants for severe pain after surgery or for intense pain.

Muscle Relaxants

Muscle relaxants help ease lower back pain from muscle spasms. These spasms can happen due to injuries, conditions like fibromyalgia or multiple sclerosis, or as a side effect of other treatments. Muscle relaxants are a common choice for healthcare providers, especially for low back pain. They can also be combined with OTC medications.

Muscle relaxants work by calming down muscle contractions (shortening or squeezing of the muscle), making the muscles more relaxed. This helps reduce pain and improve movement.

Some examples of skeletal muscle relaxants are baclofen, Zanaflex (tizanidine), and Robaxin (methocarbamol).

You might take muscle relaxants for sudden back pain, sprains, or conditions like fibromyalgia or multiple sclerosis. They can ease muscle spasms and help manage pain better for sudden back pain. In conditions like fibromyalgia, they can ease muscle pain. But usually, they're part of a plan that includes other things like exercise or physical therapy.

Muscle relaxants can cause side effects like:

• Drowsiness

• Dizziness

• Fatigue

• Weakness

Muscle relaxants may also interact with other medications, like sedatives, so it's best to be careful when using them together.

NSAIDs

Prescription-strength NSAIDs are available to help manage pain that is too severe to treat with OTC medications. They can be used for pain or inflammation associated with health conditions such as arthritis or ankylosing spondylitis or for injuries like muscle sprains or strains.

Examples of prescription NSAIDs include:

• Celebrex (celecoxib)

• Mobic (meloxicam)

• Indocin (indomethacin)

• Ketorolac

Opioids

Opioids are effective at easing pain because they attach to opioid receptors in the body that block or reduce pain signals. However, they can lead to substance use disorder and other serious health problems, so it's important to be careful when taking them. For this reason, healthcare providers usually only prescribe them when other pain relievers aren't enough.

Some examples of commonly used opioids include morphine, oxycodone, and fentanyl.

Opioids are helpful for managing severe pain, like after surgery or injuries.

They have some side effects related to them. Common side effects are:

• Painful or difficult bowel movements

• Dizziness

• Tiredness

• Feeling sick

• Slowed breathing, especially if taken in big doses or with other drugs like alcohol

Opioids don't mix well with certain drugs, like benzodiazepines. The combination can make you more tired or slow your breathing to the point of respiratory depression. Talk to your healthcare provider about the safety considerations and potential drug interactions with opioids before starting treatment.

Antidepressants

Antidepressants aren't just for mental health conditions like depression or anxiety—they can also be used for reducing lower back pain.

Two common types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs), like Cymbalta (duloxetine), and tricyclic antidepressants (TCAs), such as amitriptyline and Pamelor (nortriptyline).

SNRIs work by blocking the reabsorption of two chemicals in the brain called serotonin and norepinephrine, which helps with mood. Even though they're mainly used for depression or anxiety disorders, they also work for certain types of pain. For example, Cymbalta, a type of SNRI, is used to treat nerve pain related to diabetes.

Common side effects related to SNRIs are:

• Nausea or vomiting

• Hard bowel movements

• Watery bowel movements

• Dry mouth

TCAs work by increasing serotonin and norepinephrine in the brain.

Common side effects related to TCAs are:

• Tiredness

• Dry mouth

• Hard bowel movements

It's important to be cautious with TCAs if you have certain heart problems. Also, combining them with other medications that affect serotonin levels can cause a serious condition called serotonin syndrome.

Other Ways to Manage Low Back Pain

When treating lower back pain, many healthcare providers first think of treatments without medications. Using ice or heat, massages, acupuncture, or spine adjustments are good options for lower back pain.

For chronic pain, exercises for the mind and body, like yoga or tai chi, may be helpful.

Summary

When choosing a medication to help relieve lower back pain, consider the severity and underlying cause.

OTC medications can help with short-term pain and are often used first. In some cases, stronger medications, like muscle relaxants or opioids, are needed and prescribed by a healthcare provider.

Each of these medications works differently and has its place in pain treatment. You may only need one for quick relief or require a longer-term treatment plan involving other methods, such as physical therapy or acupuncture.

Everyone responds differently to pain and pain medications. For this reason, work closely with your provider to determine the right treatment path for you. Factors like age, other health problems (comorbidities), and what a person wants from the treatment are also considered.

The author would like to recognize and thank Norma Ponce, PharmD, MHA, for contributing to this article.

Read the original article on Verywell Health.