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."
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
- 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.
In some cases, however, narcotics can be necessary. “I’ve seen patients who’ve had multiple back surgeries and have been on morphine for 10 years, and that’s the only way they can mange their pain,” Jung says.
But caution is warranted. In fact, long-term opioid use may make back pain worse. “There’s data coming out now that being on these medications for long periods, at high enough doses, can change the nervous system so that you actually perceive pain more. I try not to encourage chronic use, although some people just can’t come off those medications enough to function.”
Like anti-inflammatory drugs, corticosteroids can also relieve inflammation and alleviate back pain. They can be taken either orally or via injection into your back.
“Steroids are the most powerful anti-inflammatory that we have in our arsenal,” says Jung. A short course of oral steroids might even be tried before opioids when someone has had serious back pain for a few weeks, without relief from NSAIDs and muscle relaxants. This could calm inflammation down before it becomes chronic.