Medications used to Treat Acute Low Back Pain

By Chelsea Commander, APRN, FNP-C

Acute low back pain with or without sciatica is one of the most common reasons for adults to see a physician. Although most patients recover quickly with minimal treatment, proper evaluation is needed to identify cases of serious underlying pathology. Certain red flags should prompt aggressive treatment, whereas others are less concerning. If no red flags such as neurological deficits are present, and if the symptoms have been present for less than 8-12 weeks, most often cases are first treated with medications. Medications for acute low back pain and sciatica include non-steroidal anti-inflammatories, muscle relaxers, oral steroids, and pain medications. This article will briefly discuss each class of medication used to treat acute low back pain.

Non-steroidal anti-inflammatories (NSAIDS) are often first line for acute low back pain. They reduce pain and inflammation. Examples include Motrin, Naproxen, and Lodine. Switching to a different NSAID may be considered if the first is ineffective. NSAIDs used in high doses or for extended periods of time can cause gastrointestinal problems such as gastritis or ulcers. They also should be used in caution in patients with a history of heart disease.

Non benzodiazepene muscle relaxers such as Flexeril, Robaxin, Skelaxin, and Zanaflex can be beneficial in treating low back pain that is associated with muscle spasms. Adverse effects include drowsiness, dizziness, and nausea. Muscle relaxants combined with NSAIDs may have additive benefit for reducing pain.

A short dose of oral corticosteroids may be used to help treat patients with acute radicular leg pain.  They reduce pain and inflammation much like NSAIDs. This medication is used in short intervals, usually with tapering doses such as a Medrol Dose pack. Chronic use of oral steroids for low back pain should be avoided to prevent adverse effects such as diabetes, cataracts, and osteoporosis. It is important to note that diabetics should not use oral steroids since the medication increases blood sugar. Steroids should also not be taken by patients with an active infection (e.g. sinus infection, urinary tract infection) because they can make the infection worse.

Pain medications such as opiods are commonly used to treat severe acute low back pain, however there is little evidence of benefit over NSAIDs coupled with muscle relaxers.  These medications should be used sparingly and on an as needed basis as they can be habit forming. Examples include codeine, hydrocodone, and oxycodone. Pain medications can be highly effective in treating back pain for short periods of time (less than two weeks). After the initial two weeks, the body rapidly builds a natural tolerance to narcotic medications and they lose their effectiveness to treat acute pain. While some narcotics can be used long-term to treat chronic pain, narcotics are most commonly used to treat severe acute (short-term) low back pain or post-operative pain.

Prescription medications should always be taken as instructed by your health care provider. They should never be shared with other people and you should never take something that isn’t prescribed to you. If you think you need treatment for back pain, call and make appointment with a health care provider today.