What medication for my back pain? (Benefits and limitations)

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

You are wondering about the best medications that can relieve your back pain. Which to choose between anti-inflammatories, muscle relaxants or painkillers? Can they treat the cause of the problem, or do they just mask the symptoms? What philosophy to adopt when you want to take medication for your back pain?

The goal of this article is to educate you about the role of medication in low back pain, so that you'll be an educated and knowledgeable patient at your next doctor's visit (and you'll look very smart in front of your doctor, believe me). me!).

WARNING: First of all, you have to understand that I am not a doctor. So don't ask me to recommend anything for your back pain. For that, it will therefore be necessary talk to your doctor for whom will be able to prescribe the right medications for you based on your medical history, other health problems, tolerance and dependence, etc.

Minimalist approach with medication

«I don't know about you, but personally I hate using drugs!»

Let's start by summarizing the basics when discussing medication for low back pain: "ONE SHOULD IDEALLY TAKE THE MINIMUM MEDICATION, AT THE MINIMUM DOSE, FOR THE SHORTEST TIME POSSIBLE."

I don't know about you, but personally I hate using drugs! Besides, if your doctor doesn't adopt this minimalist philosophy when he prescribes anything for you, I'm afraid he's not basing his practice on the latest scientific data!

The problem with drugs

When you are in pain, you absolutely want to reduce your pain as quickly as possible. This is completely normal and justified. The problem is that some drugs are mainly short-term, and can cause sometimes harmful side effects.

Is it worth it? It's up to you (there really isn't a right answer, actually…)

The other problem with drugs is that you can become "addicted" to them. On the one hand, this will mean that it will be necessary to constantly increase the doses to obtain the same therapeutic effects. On the other hand, you may experience withdrawal symptoms when your doctor (and you) decide to reduce the doses. This is all the more true if weaning is done early and aggressively.

The most frequently encountered symptoms are (they depend of course on the type of drug consumed, and especially concern “stronger” drugs such as opioids):

• headaches
• nausea
• Nightmares
• Mood disorders
• Weakness
• sweats
• Diarrhea
• Just to name a few

You will understand the reasons why it is a bygone practice to prescribe a large amount of high-dose medication to treat pain.

The therapeutic approach with drugs

We therefore speak of first-line, second-line or third-line treatments when referring to the treatment of low back pain. Ideally, you should exhaust one type of treatment and switch to another ONLY if it proves ineffective, or reaches a therapeutic plateau (ie. it stops working).

So, it is always better to try to relieve your symptoms in a “natural” way. You probably already know that. On the other hand, when the pain is so incapacitating that it prevents us from functioning, we sometimes have to resort to taking medication.

So here is the general procedure that doctors follow when their patient complains of exacerbation of back pain:

Low back pain management

• Prescription ofnonsteroidal anti-inflammatory drugs (NSAIDs) if you have no contraindications (these drugs can potentially irritate the stomach and kidneys, in addition to affecting blood pressure). Although less effective, the alternative would be to use acetaminophens as they cause fewer complications. Note, however, that we can still observe liver problems, kidneys, ulcers and others in those who consume excessively. Some doctors prescribe a combination of NSAIDs and acetaminophen to find the best of both worlds.

• If NSAIDs and/or acetaminophen do not work, your doctor may prescribe muscle relaxants. This type of medication should be used especially when there is increased pain, and should not be taken for a prolonged period because of side effects on the nervous system.

• In more chronic cases, your doctor may prescribe opioids. Again, it is best to use these medications only when there is a severe exacerbation of lower back pain. Indeed, there is a risk of dependence, especially in more “vulnerable” patients (history of dependence on medication, drugs or alcohol, for example).

• In the case of radiculopathies (ie. pain that radiates down the leg, sometimes associated with numbness and tingling), the doctor may prescribe antiepileptic like Gabapentin or Pregabalin. However, these medications are considered unpleasant by many clients considering their side effects (fatigue, dizziness, dry mouth, visual disturbances, etc.).

Conclusion

As you have seen, there are beneficial effects to drugs (such as pain reduction!), but also harmful effects. Your doctor will be able to give you the best recommendations based on your personal condition (And yes, each case is different!).

Just keep in mind that you always have to weigh the pros and cons when taking any pill. In other words, the effectiveness of the drug must outweigh the side effects that the patient will potentially experience. It is for this reason that the golden rule is essential:

"TAKE THE MINIMUM MEDICATION, AT THE MINIMUM DOSE, FOR THE MINIMUM TIME POSSIBLE."