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 valdecoxib (Bextra).

COX-2 inhibitors are less likely to cause stomach problems,