Medications

Overview

Neck and back problems are the second most common reason patients seek medical attention. Fortunately, the vast majority of patients recover with or without medical treatment. However, patients who develop acute, sudden neck or back pain may suffer significantly until it resolves, which may be days or even weeks. Chronic spinal conditions may take months or years to settle down on its own. Therefore, most physicians recommend the use of medications to help relieve spinal pain and speed up the recovery process.

Because spinal disorders often generate pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequently prescribed analgesic medications for mechanical neck and back pain worldwide and are very effective. NSAIDs include ibuprofen and naproxen, and are available over-the-counter without a physician prescription. Stronger NSAIDs such as ketorolac or indomethacin are also available by prescription. NSAID medications work by reducing the inflammation and swelling, which typically reduces the pain as well. NSAIDS should not be used by patients with severe kidney disease.

Acetaminophen (Tylenol) is a common, over-the-counter medicine that favorably decreases pain in many patients with spinal pain. Acetaminophen should not be used by patients with severe liver dysfunction.

Muscle relaxants are another category of medicine, which are routinely prescribed for spinal disorders. These medications work by decreasing the muscle spasms, which can be promoting the pain and inflammation.

Narcotic (opiods) are controlled, prescription medications that are used specifically for pain. Narcotic medications, such as Tylenol with codeine or Tylenol with oxycodone, are mainstays for the short-term treatment of severe neck or back pain, but should be used sparingly for patients with chronic spinal pain.

Corticosteroids such as methylprednisolone or prednisone are appropriate for patients with significant radicular nerve pain, such as sciatica from a disc herniation. However, patients with diabetes should be carefully followed because steroid medicines can disturb sugar metabolism. Anticonvulsants medications, which can stabilize neural membranes and decrease nerve inflammation, are frequently effective for patients with significant neuropathic pain unrelieved with other medicines or treatments.

Overall, nearly 99% of patients with a spinal disorder do not require surgical treatment and improve with conservative treatment. Specific oral (taken by mouth) medications listed above generally allow patients with spinal pain to improve, and improve more rapidly, as well reduce inflammation and the likelihood of a recurrence of symptoms.

Selected Bibliography

Atkinson JH, Slater MA, Wahlgren DR: Effects of noradrenergic and serotonergic antidepressants on chronic low back pain intensity. Pain 1999 Nov; 83(2): 137-45.

Borenstein D: Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Curr Opin Rheumatol 1996 Mar; 8(2): 124-9.

Cherkin DC, Wheeler KJ, Barlow W: Medication use for low back pain in primary care. Spine 1998 Mar 1; 23(5): 607-14.

Van Tulder MW, Scholten RJ, Koes BW: Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev 2000; (2): CD000396.

Von Feldt JM, Ehrlich GE: Pharmacologic therapies. Phys Med Rehabil Clin N Am 1998 May; 9(2): 473-87.