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.
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.”