Spinal Pain (Back & Neck) Oral Medication Treatment Options

There are a variety of over the counter and prescription medications that are used to treat back and neck pain.  Which one should any particular patient take, how do they work, and what affect do they have on your body?  This blog will discuss the different oral medication  options and hopefully help you create some educated questions to take to your pharmacist or doctor.

Lets be clear, back and neck pain may have many different underlying causes, and quite often, the exact known cause of pain for any one particular patient may go unknown for quite some time.  Most people with chronic back or neck pain (pain that persists for more than three months) will treat them selves with over the counter therapies until the pain becomes unbearable and they find themselves at their doctors office or in an urgent care clinic of some kind looking for relief. 

There are different treatment alternatives that include diet, stretching,  physical therapy, exercise, chiropractic manipulation, surgical procedures,  topical medication, injectable medication and oral medication therapy.  It is important to discuss with your doctor which is the best combination of treatments for  you, however, my goal here is to help educate you about the different oral  medication treatment options.

Acetaminophen (Tylenoltm) is an effective non-prescription medication for back/neck pain and generally has very few side effects.  Acetaminophen does not have any anti-inflammatory effects, rather, it blocks the perception of the pain.  Acetaminophen has the benefit that there is no chance of addiction, it rarely causes stomach upset and you do not develop a tolerance to the medication.  The risk with acetaminophen is that it is easy to take too much of it, which may cause serious liver problems.  Please read the packaging and do not take more acetaminophen than is directed on the label.  Also, please be aware, many prescription medications contain acetaminophen in combination with another medication.  Be sure to keep track of your daily acetaminophen dose to be sure you do not get more than 3000-4000mg daily. 

Ibuprofen (Motrin IBtm, Adviltm) and Naproxen (Alevetm) are two non-prescription non steroidal anti-inflammatory medications available.  Ibuprofen and naproxen work differently than acetaminophen to relieve pain, so, a patient in significant pain may take the recommended dose of acetaminophen alternating with the recommended dose of ibuprofen or naproxen and repeat this pattern as appropriate to treat the pain. 
Prescription Oral Medications options.

Non-Steroidal Anti-Inflammatory Medications:  Celecoxib (Celebrextm), Diclofenac (Voltarentm), Edotolac (Lodinetm), Ibuprofen (Motrintm), Meloxicam (Mobictm), Nabumatone (Relafentm), Naproxen (Naprosyntm Anaproxtm), Piroxicam (Feldenetm)
These medications work best when taken on a regular basis.  The idea is that the medication build up in the system and work to block the inflammatory process.  A muscle may be inflamed and pressing against a nerve in the spine causing the pain.  This decrease in inflammation creates a better environment for healing.  There are a number of potential risks and side effects associated with each specific non-steroidal anti-inflammatory agent such as gastrointestinal irritation or cardiovascular side effects.  Please talk with your doctor to decide which medication would be best for your specific condition. 

Nerve Pain Medications:  Pregabalin (Lyricatm), Gabapentin (Neurontintm), Duloxetine (Cymbaltatm)
These medications work to interfere with specific signals in nerve pathways that have to do with the transmission of pain impulse recognition.  These medications are usually not addictive and may be taken safely for long periods of time.  That said, this category of medications is sometimes difficult for people to start.  The dose of any of the three will most likely be titrated up slowly over a course of 1-4 weeks to minimize the side effects.  It helps to know that the body will usually acclimate to the medication over the course of a few weeks and the side effects will diminish as the pain control increases. 

Narcotic Pain Medications:  Oxycodone/Acetaminophen (Percocettm
), Hydrocodone/Acetaminophen (Vicodintm, Norcotm, Lorcettm), Oxycodone Extended-Release (Oxycontintm), Fentanyl Patch (Duragesictm), Morphine Extended Release (MS Contintm, Avinzatm, Kadiantm) Narcotic pain medications(opiates)  work very well at treating back and neck pain for short term therapy like you might need after a surgery or an acute injury of some kind.   The opiates block the perception of the pain in the central nervous system.  They don't actually do anything to where the pain is coming from, they just block your perception of it so you have a decreased sensation of the pain.  One of the big issues with opiate pain therapy is that after 2-3 weeks of treatment, the body slowly begins to build up a tolerance to the medication.  This may sometimes be perceived  as an increase in pain, rather than a decrease in effectiveness and the dosage may be increased.   If not monitored and talked about regularly, this can lead to a self-defeating addiction to opiates  with an escalating need for pain control.  That said, there are some physicians who use low dose, long-acting opiates to treat chronic back and neck pain effectively for long periods of time.  Please discuss all aspects of narcotic pain control with your doctor or pharmacist before beginning chronic opiate pain control. 

Corticosteroid Medications: Dexamethasone, Methylprednisolone, Prednisone
Corticosteroids are sometimes used for short term therapy(7-14 days)  to decrease inflammation in an acute situation.  There are generally only a few complications associated with short term use of corticosteroids such as upset stomach, restlessness and agitation.  Long term use of corticosteroids may be associated with osteoporosis, compromised immune system, stomach ulcers and possible other complications.  Please note that caution should be used when someone with diabetes is prescribed a corticosteroid beause this medication increases blood sugar.  Also, if steroids are used in someone with an acute infection, the infectious condition may worsen.  Please make sure your doctor and pharmacist are aware of your current medical conditions and other medications before you begin a course of oral corticosteroids.  

Muscle Relaxants: Diazepam (Valiumtm), Cyclobenzaprine (Flexeriltm), Carisoprodol (Somatm), Tizanidine (Zanaflextm),  Methocarbamol (Robaxintm)
Muscle relaxants may be prescribed for an acute flare up of back or neck pain when the pain is associated with a spasming muscle.  This type of medication may help relax a muscle that is spasming around a nerve thereby decreasing the pressure that the muscle is placing on the nerve and decrease the pain.  The trouble with this approach is that the muscle relaxant is not specific for the muscle that is spasming.  All of the muscles will be relaxed and may significantly decrease your reflex response capability.  In other words, don't drive and don't drink any alcohol while taking these medications.  Quite often this category is prescribed for back or neck pain to help relax a muscle so someone may sleep at night.   Please discuss with your doctor or pharmacist how long you should take your muscle relaxant for and to make sure you are aware of the important information associated with your specific muscle relaxant. 

Other:  Tramadol (Ultramtm)
Tramadol is an alternative to opiate pain medications for treatment of moderate to moderately severe acute pain such as you might have post-operatively or after an acute injury.  Tramadol is not a narcotic; however, it works by stimulating the same opioid receptors in the central nervous system that opiates do.  It also has decreases pain by increasing the levels of specific neurotransmitters, similar to how the nerve pain medications work.  This medication has a much less chance of addictive behavior associated with it; however, because it does work in the central nervous system, you still need to be aware of the potential of side effects such as light headedness, dizziness and drowsiness.  It is important to note that someone would usually not take Tramadol and an opiate at the same time because one may block the effects of the other.   Please discuss this option with your doctor as an alternative to taking short acting narcotic pain medications.

This is meant as a general over view of the oral medications commonly used for treatment of back and neck pain.  Please discuss with your doctor what the best course of treatment is for your situation.  If you have any questions about any of the medications listed here, I encourage you to contact your community pharmacist and engage them in a discussion

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