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Other topical treatments that can be used for pain contain ingredients such as capsaicin, camphor, menthol, and eucalyptus oil.

Muscle Relaxants

If over-the-counter pain relievers or prescription NSAIDs are not relieving your back pain, your doctor may suggest adding a muscle relaxant. These medications include:

  • Cyclobenzaprine (Flexeril)
  • Tizanidine (Zanaflex)
  • Baclofen (Lioresal)
  • Carisoprodol (Soma)

There are many brand names in the same category, says Jung. They help relieve the muscle spasms that are causing your back pain. 

Muscle relaxants may be particularly useful for acute injuries (such as straining your back playing basketball), says Jung. For example, carisoprodol (Soma) significantly reduced back pain and improved function after three days of treatment, according to the results of clinical trials presented at the American Academy of Pain Medicine's 2010 annual meeting.

Most of these drugs have similar side effects, with drowsiness being the most common. "They can be quite sedating," Jung says. "If you’ve never tried them before, don’t operate heavy machinery or drive until you know how they affect you. I usually start patients on these at night to see how they react."

Opioids

For some patients, NSAIDs and muscle relaxants are not enough. People with long-lasting, chronic back pain, particularly after multiple surgeries, are sometimes prescribed opioid or narcotic medications. In fact, one study showed that as many as 70% of back pain patients receive opioids, which some experts suggest is probably too many.

These drugs act on pain receptors in the brain and nerve cells to alleviate pain. Jung says there are milder, shorter-acting versions, such as Vicodin (acetaminophen and hydrocodone) and Tylenol with codeine -- which is what most people begin with -- as well as stronger drugs like morphine.

Their most common side effects include:

  • Drowsiness and sedation
  • Constipation
  • Risk of dependency
  • Allergic reactions, such as hives and itching

There’s also a step between NSAIDs and muscle relaxants and a more classic opioid or narcotic drugs. Tramadol (brand names Rybix, Ryzolt or Ultram) also acts on the opioid receptors in the brain, but it is weaker compared to morphine or hydrocodone, so it’s not regulated like a controlled substance, says Jung. “So it’s a milder approach and patients who don’t want to move on to narcotics often think that’s a good option, he says.

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