Back Pain Medications and Injections
Back Pain Medications and Injections
By Brennan Howe
Among the common pain relief medications prescribed by physicians
are muscle relaxants, antidepressants, NSAIDs (nonsteroidal
inflammatory drugs) and COX –2 inhibitors. Some popular muscle
relaxants are cyclobenzaprine (Flexeril), carisoprodol (Soma),
methocarbamol (Robaxin) and gabapentin, in seizure medications.
The NSAIDs help with stiffness and in reducing inflammation.
Opiates like Duragesic or OxyContin may be prescribed but are not a
popular choice with a low risk of possible addiction.
With all medications, other treatment strategies should be combined
into the relief program. So physical therapy, movement and
posture techniques and other treatment options should be carefully
assessed to see which combination best helps relief over time.
Doctors may also prescribe injections, such as Sacroiliac joint
blocks, Thoracic Facet Joint injections, Epidural steroid
injections, selective nerve root block, and Facet rhizotomy.
Muscle relaxants act on the brain, not on the muscle. They
help relieve pain so that patients are able to exercise and have
other physical treatments that would otherwise be too painful.
Muscle relaxants are sedatives, so doctors may prescribe them to be
taken at night to avoid daytime drowsiness. They should not be
taken when driving or operating heavy machinery. Muscle
relaxants have been shown to be effective alone or in conjunction
with anti-inflammatory medications within a week of the onset of
severe muscle spasm in the lower back. Side effects include
drowsiness, dizziness, addiction after one week of use, dry mouth
and urinary retention. Some common muscle relaxants are
carisoprodol (Soma), cyclobenzaprine (Flexeril), diazepam (Valium),
metaxalone (Skelaxin), methocarbamol (Robaxin).
Low doses of tricyclic antidepressants have been used to relieve
chronic back pain. They work by increasing the level of
certain chemicals in the brain that change the way the brain
perceives pain. They are not used for sudden and acute pain,
and usually take two to three weeks to go into effect. Side
effects include constipation, dry mouth, blurred vision, drowsiness,
fatigue, low blood pressure, weight gain, increased appetite,
sweating, and urinary retention. Since side effects vary from
medication to medication, it is worth trying another antidepressant
if one does not work well. Some common antidepressants used to
treat are amitriptyline (Amitril, Elavil, Endep), doxepin
hydrochloride (Sinequan), imipramine hydrochloride (Janimine,
Tofranil), nortriptyline (Pamelor), and desipramine (Norpramin).
NSAIDS and COX-2 inhibitors are effective in relieving pain and
reducing inflammation. They are generally the first line of
treatment in acute low back pain. NSAIDS are usually taken for
one to three weeks but can be taken for four weeks or longer.
People under the age of twenty should not take NSAIDS because they
can cause Reye’s syndrome, a central nervous system disorder.
Other people who should not take NSAIDS include those taking blood
thinners, corticosteroids, lithium, and oral antidiabetic
medication. Before taking NSAIDS you should let your doctor
know if you are pregnant, trying to get pregnant, breastfeeding, or
have a peptic ulcer, history of gastrointestinal bleeding, nasal
polyps, kidney or liver disease, allergic reactions to aspirin or
related drugs, anemia, or a blood-clotting defect. Short-term
side effects can include stomach irritation, which can be minimized
by taking them with food and a full glass of water. Taking
NSAIDS long term can cause ulcers. In rare cases, naproxen,
ibuprofin and rofecoxib have caused meningitis. A common
nonprescription NSAID is aspirin (Anacin, Bayer, Bufferin). A
common prescription NSAID is naproxin (Naprosyn). Some common
COX-2 inhibitors are celecoxib (Celebrex), rofecoxib (Vioxx), and
COX-2 inhibitors are less likely to cause stomach problems,
may increase the risk of heart attack. If you have a history
of heart trouble, talk to your doctor to see if COX-2 inhibitors are
best to treat your back pain.
Spinal injections have been used to as an alternative to surgery in
treating since the early 1900s. Studies have shown
injections to be effective in up to 50% of patients. They are
typically given after medication and physical treatments have been
utilized, but before surgery. Injections tend to be more
effective than oral pain medication because they deliver medicine
right to the source of the pain.
Sacroiliac (SI) joint blocks are injections used to treat low back
pain. The sacroiliac joints are located next to the spine and
connect the sacrum to the pelvis. Painful joints cause pain in the
lower back, buttocks, abdomen, groin, and legs. SI joint
blocks work in three ways: 1) they are used to determine if the SI
joint is the source of (if the injection makes the pain
better, that’s where the pain is coming from), 2) the numbing
medication used in the block gives temporary relief so the patient
can have chiropractic or other physical treatments immediately after
the block is administered, and 3) a time-release steroid gives
extended pain relief by reducing inflammation.
During an SI block, the patient lies on his stomach and live x-ray,
known as fluoroscopic guidance, is used to allow the doctor to see
the joints. The skin is sterilized and numbed. The
doctor then inserts a very small needle into the joint and injects
it with lidocaine (a numbing agent) and a steroid (an
anti-inflammatory). After treatment the legs sometimes feel
numb or weak for a few hours. Side effects are rare and
include allergic reaction, infection, excessive bleeding, nerve
damage, and chemical meningitis.
Thoracic Facet joints are small joints about the size of a thumbnail
and are located in pairs along the back of the spine. If they
become irritated, middle occurs. Thoracic facet
joint injections have the same purpose as SI joint injections, are
performed in exactly the same manner, and have the same side
effects. The only difference is they treat middle
instead of lower back pain.
Epidural steroidal injections are similar to SI and thoracic facet
join injections, except the cortosteroid is injected into the spinal
canal surrounding the spinal cord. They are used to treat
chronic and not acute low back pain. This procedure has the
same side effects of other injections. Relief generally lasts
anywhere from one week to one year.
Selective nerve root blocks (SNRB) are used primarily as a
diagnostic tool and secondarily as treatment for pain. Back
pain can occur when nerve roots become compressed and inflamed.
While MRIs can be used to show which nerves are causing the pain,
they don’t always work successfully. In cases when this
happens, an SNRB injection can be performed in order to isolate the
source of the pain. SNRBs are also used to treat disc that
rupture outside of the spinal canal, or far lateral herniated discs.
The procedure is the same for other types of injections. As
with other injections, SNRBs should not be performed more than three
times per year. SNRBs are considered more difficult to perform
than other types of injections and should be done only by a
physician experienced in them.
Facet rhizotomy may be recommended if three facet blocks have been
performed but more pain relief is needed. Facet rhizotomy
injections disable the sensory nerves that lead to the facet joint,
thereby providing pain relief. The procedure for facet
rhizotomy injections is different from that of other injections.
A needle with a probe is inserted just outside the joint, is heated
with radio waves, and applied to the sensory nerve. This
disables the nerve and keeps it from sending pain signals to the
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