The best meds for back pain

Find the right medications for you and use them correctly.

Just about everyone gets back pain. In fact, an estimated 80% of people will seek medical attention for back pain at some point in their lives. Most of the time, popping a few over-the-counter pain relievers does the trick. But are drugs the best way to combat regular flare-ups?

"Medication can be a crucial part of managing and treating occasional and recurring pain, and can help you stay pain-free and active, but you have to use the right ones for you, and in the right way," says Dr. Robert Shmerling, former clinical chief of rheumatology at Harvard-affiliated Beth Israel Deaconess Medical Center.

The source of back pain

A lot of back pain in older men is caused by weak core muscles and declining muscle mass. However, pain also could be related to osteoarthritis, an injury, or even depression. "It's always important to get checked out by your doctor if your pain does not subside after a few weeks, or right away if it's accompanied by other conditions like leg weakness, incontinence, or a fever," says Dr. Shmerling.

Keep in mind that NSAIDs might not always be the best medicine for back pain. A study published online Feb. 2, 2017, by Annals of the Rheumatic Diseases reviewed 35 placebo-controlled studies that included more than 6,000 people who had all sorts of spine-related pain, including neck pain, low back pain, and sciatica.

There are several categories of back pain medication. The common ones include nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, muscle relaxants, and antidepressants. What's your best option? It depends on your particular pain and how your body reacts to the medication and dosage.

"Advertisements pitch a particular drug as if it would work for everyone, but back pain varies from person to person, as does its response to drugs," says Dr. Shmerling.

Here's a look at these types of drugs and how they help with back pain:

NSAIDs. NSAIDs are often the go-to drugs for back pain relief. They can be purchased over the counter (or, in higher doses, by prescription) and include ibuprofen (Advil) and naproxen (Aleve).

NSAIDs help reduce pain, swelling, and inflammation in muscles and around damaged spinal discs or arthritic joints. Acetaminophen (Tylenol) is also a pain reliever and often sold alongside NSAIDs, but it's not an NSAID and does not help with inflammation. (People with liver disease should avoid acetaminophen, says Dr. Shmerling.)

Because NSAIDs are easy to get, people tend to overuse them, which can expose them to possible side effects like stomach pain, ulcers, bleeding, or even kidney damage.

There is no recommended standard dosage for NSAIDs for back pain. "Follow the guidelines on the label, and let your doctor know what you are taking and how much," says Dr. Shmerling.

Keep in mind that NSAIDs might not always be the best medicine for back pain. A study published online Feb. 2, 2017, by Annals of the Rheumatic Diseases reviewed 35 placebo-controlled studies that included more than 6,000 people who had all sorts of spine-related pain, including neck pain, low back pain, and sciatica.

While people who took NSAIDs had less pain and disability after starting treatment than before, the effect was quite small and similar to improvements reported by those who received a placebo.

Also, those who took NSAIDs were two-and-a-half times more likely to experience side effects. "This doesn't mean that NSAIDs can't help you, but only that they don't work for everyone," says Dr. Shmerling.

Opioids. If your back pain becomes more severe, you may benefit from a stronger prescription drug like an opioid. Opioids, such as oxycodone (OxyContin) and an acetaminophen/ hydrocodone combination (Vicodin), interact with receptors on nerve cells in the body and brain to reduce pain.

Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but there is always a concern about addiction. "This is why they should be considered a last resort after careful consideration with your doctor about possible risk factors," says Dr. Shmerling.

Muscle relaxants. Prescription muscle relaxants act on the central nervous system to reduce acute pain for the short term and are often recommended when muscle spasms are present. However, many make you drowsy, so you have to be careful how you use them.

Antidepressants. Doctors prescribe certain antidepressants off-label to help manage pain, including chronic low back pain, even if the person is not depressed.

Some research has found duloxetine (Cymbalta), which is used to treat depression and anxiety, to be one of the more effective antidepressants for treating pain.

Antidepressants are not addictive and are well tolerated by many people. Speak with your doctor about whether this may be an option.

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