What are the best medications for back pain?09 Oct 2013
Dr Peter Lacey is a UK General Practitioner who specialises in back pain.
He has worked closely with world-renowned physiotherapist Sarah Key to help hundreds of patients find relief from the agony of back pain.
Broadly speaking, says Dr Lacey, back pain is caused by tissue damage of the facet joint or the intervertebral disc.
You can reduce back pain in two ways when using back pain medications:
- By working locally to damp down pain by reducing the inflammation at the site of trouble.
- Or, by modifying perceptions of pain at a higher level in the brain.
Back pain drugs that work at local level at the site of inflammation are called ‘non-steroidal anti-inflammatory drugs’ or NSAIDs, such as ibuprofen (Nurofen).
Painkillers such as Paracetamol work at brain level.
“Nobody is quite sure how Paracetamol works,” Dr Lacey admits, but it is a highly effective painkiller in low back pain.
Dr Lacey says back pain tissue damage at local level leads to bleeding and swelling.
“That swelling stimulates pain nerve fibre endings, he says.
“Messages about the tissue damage and inflammation are conducted along the nerve pathways to the spinal cord.
Local pain caused by tissue damage
“They then travel up to the spinal cord to the brain where they are registered as pain. Various protective mechanisms such as ‘protective muscle spasm’ come into play, which may also need to be controlled by back pain medication.
“Protective 'muscle stiffness' is a defence mechanism that the body puts in place to stop the damaged part being hurt any further by movement before it’s ready. Un-remitting spasm can become a source of pain in its own right, constituting a third factor that can add to the pain."
In summary, there is local pain caused by tissue damage, the brain’s processing of that pain and the spasm that sets in. All three can fuel each other in a vicious circle of pain, spasm and immobility.
The principles of pain relief in low back pain are to break that vicious circle.
Luckily for us there are well-established and researched back pain medications that can be used on all three contributors to pain at local level, brain level and spasm.
Tissue damage and inflammation at local level
"The body does not like blood outside a blood vessel, says Dr Lacey.
“Blood is irritating to the tissues and that’s why a bruise is so painful. Tissue damage causes the release of complex chemicals such as prostaglandins at the seat of pain to bring on inflammation and swelling. This stimulates an increase in the blood supply to the damaged tissue and helps to promote and speed repair.”
Inflammation, though painful, plays an invaluable role at the site of damage.
By reducing the production of inflammatory chemicals, you can reduce the swelling and diminish the pain signals sent to the brain.
"The group of back pain medications that works best to reduce inflammation at local level are 'non-steroidal anti-inflammatory drugs' or NSAIDs, Dr Lacey says.
Commonly used NSAIDs are Ibuprofen, (Brufen, Advil, Nurofen) and Diclofenac (Voltaren, Voltarol, Fenac) and the father of them all, Aspirin.
"With using NSAIDS, we are looking to reduce the local inflammation without completely switching it off. We do this by using the right doses of NSAIDS regularly for a few days.”
Dr Lacey says humans are very predictable when it comes to using medications.
“My patients always say to me: “If you can buy it at the supermarket or over the counter it can’t be any good for me. I want the best and only my doctor can prescribe that.”
Question: Do you know the name of the best and safest centrally-acting painkiller we have? Is it Codeine perhaps, or Morphine, or Pethidine?
Answer: It’s none of the above. It is Paracetamol.
Paracetamol is very effective taken regularly, says Dr Lacey.
“Two tablets every four to six hours is ideal so that you are not waiting for the pain to return. It is particularly good have this medication cover while you are doing something physical to try to fix your back problem and this will help you switch off the pain and get on with your life.”
You can’t become addicted
Dr Lacey believes paracetamol is probably been the most under-rated painkiller or pain-controller of all time.
“Even pain specialists have cottoned-on to this fact in the last few years, he says. “Increasingly, it is being used intravenously for post-operative pain relief because it doesn’t make you sleepy (that’s not the same as allowing you to sleep because the pain has gone away).”
Also, it doesn’t make you constipated and you can’t become addicted to it.
“What’s more, you can buy it at the supermarket and you don’t need a prescription from someone like me, Dr Lacey says.
Though Dr Lacey has a word of warning … don’t use more than eight a day.
“Even Paracetamol has its drawbacks, he says. “Taking more than eight a day can lead to liver damage.”
Protective muscle spasm
The second brain controlled mechanism that needs to be modified and reduced in the first few hours and days of acute back pain is muscle spasm, says Dr Lacey.
“It’s a brain controlled response that starts off with good intentions, but the vicous circle almost short-circuits itself and the mechanism needs a 12Amp fuse to break it and reset it.
“Protective muscle spasm creates a typical twingey 'tired' pain.
“Not many doctors like prescribing Diazepam (Valium) these days. It has rather a bad reputation, with names such as ‘mother’s little helper’ or ‘the little yellow pill’.
“It is more addictive than morphine and heroin and consequently it can be very difficult to get people off.”
But Diazepam has one saving grace: it can play a pivotal role in the arsenal of back pain medication.
It is unsurpassed in controlling centrally mediated back spasm.
“If used carefully, it will break the cycle of back pain by giving you a holiday from the hard, painful clench of the back muscles in spasm – and this will help your back move more easily and the pain to lift.
“Most pain caused by tissue damage in the back can be dealt with by these three groups of drugs: anti-inflammatories, Paracetamol and a few days – no more of Diazepam. Very few people will need more than this combination."
Dr Lacey says it is important to know you can also relieve back pain by using physical techniques designed to evacuate inflammatory products and switch off over-active muscles.
“In fact, all back pain medication works best if you are taking physical measures to help rectify the problem at the same time.”
You can learn more about these techniques in How to Relieve Back Pain compiled by Sarah Key.
Please note: This is general information on back pain medication. You need to check with your own doctor about dosages and what the most suitable NSAIDS and painkillers are for you. You also need advice on whether you need muscle spasm medication for you particular back problem.