To achieve this goal, Jung says, he frequently prescribes a dose pack of Medrol (methylprednisolone). A patient takes 24 mg the first day, then decreases the dose by 4 mg every day for a total of five or six days. "This can short-circuit the pain cycle,” says Jung.
Corticosteroid medication can also be injected into the space around the nerve roots of the spine or into the facet joints, which are spinal joints that can develop arthritis. “This delivers a powerful medication directly to the source of the pain, as locally as possible, and minimizes the side effects of taking a systemic pill,” Jung says.
How safe are steroid injections? “The consensus in the medical community is that it’s safe to get about three injections per year,” Jung says. Side effects of excessive steroid use include bone loss, weight gain, and damage to the body’s ability to process blood sugar. “I’ll see patients who will tell me they’ve done an injection every other month. That’s too much, in my opinion.”
Why would you take an antidepressant or an anti-seizure drug for your back pain? Because they can be very effective for a specific type of pain -- the kind induced by nerve problems.
“Certain antidepressants, like Cymbalta [duloxetine], and anti-seizure medications, like Lyrica [pregabalin] or Neurontin [gabapentin] have been shown to be beneficial for nerve symptoms,” explains Jung. Another class of antidepressants, known as tricyclics -- including amitriptyline (Elavil) and nortriptyline (Pamelor) -- also may be prescribed to manage chronic back pain. “So if you have a pinched nerve in the back, with pain that radiates down your leg, one of these medications can be very effective to quiet the nerve irritation and relieve the burning pain, numbness and tingling that are often involved.”
Although they vary somewhat, the antidepressants and anti-seizure medications used to treat back pain have a fairly similar lists of side effects. The more common side effects of these medications include:
- Sexual side effects
Call your doctor if you experience any of these more serious side effects:
- Allergic reactions such as hives, itching, and swelling
- Changes in heart rhythm
- Confusion or hallucinations
- Inability to sit still
- Aggression, mood swings, or other significant behavior changes
- Thoughts of suicide
No matter which medications you take for your back pain, Jung says that they should not be your only mode of relief.
“If a patient has only had pain for a few days, I don’t want to blast them with chemicals -- they may just recover on their own. With pain that’s lasted three months or more, we try to use more than one medication to alleviate their pain,” he says. “We have to get patients involved in their care. Physical therapy should be used early on. Teaching the patient to exercise, in combination with your other therapies, is a lot better than just giving them pills to take.”