What Is The Best Medicine For Lower Back Pain

Lower back pain is a common condition¹ in the United States. The lower back is a sensitive area as it’s vital for normal movement and completing everyday tasks. Daily life can be uncomfortable and challenging when you have pain in this part of your body.

Medicine plays a key role in managing and treating lower back pain and can help you stay active. It can also help prevent a more chronic lower back condition from developing. However, even medications that treat the same conditions can differ. You will need to select the right medication (or combination of medications) for you and use it in the right way.

So what is the best medicine for lower back pain?

Acetaminophen (paracetamol)

Acetaminophen, also called paracetamol, can reduce fever and ease pain. It’s a bit like aspirin, although its anti-inflammatory properties are not as effective. It is not understood exactly how acetaminophen works, but it can increase your general pain threshold. With a higher pain threshold, you won’t feel lower back pain as quickly.

Acetaminophen is ideal for people who can’t take non-steroidal anti-inflammatory drugs (NSAIDs) such as celecoxib, aspirin, or ibuprofen because of stomach irritation or blood-thinning medications (like clopidogrel, rivaroxaban, or warfarin).

Its low risks and pain-relieving properties make acetaminophen a great option for lower back pain, provided you take the recommended dose. Although acetaminophen is known to relieve headaches, toothaches, and post-surgery pain, very little evidence is available to support its efficacy in lower back pain. But cases are unique, and the few studies available² show acetaminophen may help.

Possible side effects

There is no risk of addiction with acetaminophen — you won’t develop a tolerance to the drug if you need to take a higher dose. Acetaminophen rarely causes stomach problems, but it can cause liver damage if taken in high doses. Doctors recommend limiting intake to 3000mg a day.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are a group of medications that include aspirin. They reduce inflammation and relieve pain by limiting the production of prostaglandins, hormone-like chemicals that sensitize nerve endings and create inflammation.

NSAIDs are a great choice for managing lower back pain. A single dose of most NSAIDs can reduce pain more effectively than acetaminophen.

Common types of NSAIDs include:

• Aspirin (Bayer, Bufferin, Ecotrin, St. Joseph)

• Ibuprofen (Advil, Motrin)

• Naproxen (Aleve, Anaprox DS, Naprosyn)

• Celecoxib (Celebrex)

Research into the efficacy of different types of NSAIDs in managing lower back pain found that they are similarly effective³. Generic ibuprofen is a good choice as it is less expensive and has fewer adverse gastrointestinal side effects.

Possible side effects

You may experience some side effects in the first weeks of taking NSAIDs, including digestive problems like diarrhea and nausea, stomach pain, and heartburn. Serious side effects include ulcers, internal bleeding, kidney damage, and heart problems.

Taking NSAIDs with other medications has unpredictable results. It could increase your risk of side effects and make medication less effective. Always read the instructions carefully and consult your doctor before combining NSAIDs with other medications.

Muscle relaxants

Limited evidence⁴ suggests that muscle relaxants provide short-term relief for lower back pain. Muscle relaxants are a group of drugs that ease muscle spasms and relieve pain, and your doctor may prescribe them if NSAIDs or acetaminophen haven't given enough relief.

They relax your muscles and interrupt the pain-spasm cycle either by acting on the central nervous system or the muscle itself. You might find that muscle relaxants improve your range of motion, helping you prepare for physical therapy. It is not known whether muscle relaxants are more effective than NSAIDs or whether a combination works best.

Examples of muscle relaxant drugs include:

• Carisoprodol (Soma)

• Metaxalone (Skelaxin)

• Methocarbamol (Robaxin)

• Orphenadrine (Norflex)

• Baclofen (Ozobax)

• Chlorzoxazone (Parafon Forte DSC, Lorzone, Remular-S)

• Cyclobenzaprine (Amrix)

• Tizanidine (Zanaflex)

• Dantrolene (Dantrium)

Possible side effects

A 2021 study⁵ found that muscle relaxants offer limited relief for lower back pain while putting patients at risk of side effects, so their overall efficacy remains unclear.

Dizziness and drowsiness are the most common side effects, so take care if you plan to drive or operate heavy machinery. Muscle relaxants should not be taken with alcohol as it could intensify the sedative effects. There is also a risk of drug abuse and addiction, so you should always take muscle relaxants with your doctor’s supervision.

Antidepressants

Antidepressants are usually prescribed to treat clinical depression, but they can also help alleviate lower back pain⁶ as they have analgesic (pain-relieving) effects. Lower doses are prescribed to treat pain compared to mental health conditions.

Lower back pain can take a toll on your emotional wellbeing, and the fact that antidepressants may help you cope with this is an added benefit. It is also thought that depression and anxiety increase pain perception⁷, explaining why antidepressants can effectively reduce pain in people with mental health conditions.

Antidepressants prescribed to treat lower back pain include:

Tricyclic antidepressants (TCAs)

TCAs may be prescribed to ease your lower back pain, and they can also help if your pain makes it difficult to sleep. TCAs increase the levels of some calming neurotransmitters in your brain (including serotonin, dopamine, and norepinephrine), helping you regain balance.

Examples of TCAs include:

• Amitriptyline (Elavil)

• Desipramine (Norpramin)

• Imipramine (Tofranil)

• Nortriptyline (Pamel)

Selective serotonin reuptake inhibitors (SSRIs)

Many studies suggest that SSRIs⁷ effectively reduce pain, but it’s thought that more high-quality research is needed to prove their usefulness. They work by allowing more serotonin⁸ to travel between neurons in the brain, a hormone that plays a key role in regulating mood and nociception (pain perception).

Examples of SSRIs are:

• Fluoxetine (Prozac)

• Paroxetine (Paxil)

• Sertraline (Zoloft)

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs increase norepinephrine and serotonin by preventing your brain cells from reabsorbing them. Having higher levels of these chemicals may help reduce pain.

Examples of SNRIs include:

• Duloxetine (Cymbalta)

• Milnacipran (Savella)

Possible side effects

Lower doses of antidepressants are usually prescribed to treat lower back pain, but you could still experience side effects.

TCAs' common side effects include dizziness, drowsiness, weight gain, constipation, and dry mouth. SNRIs and SSRIs may cause dizziness, insomnia, headaches, loss of libido, and stomach problems such as indigestion, constipation, or diarrhea.

Opioids

Opioid drugs are sometimes prescribed to treat acute or chronic lower back pain. They are typically only used for short-term pain relief as they can cause addiction.

Opioid molecules travel through the bloodstream and attach themselves to opioid receptors on nerve endings. This reduces the transmission of pain, making your pain less noticeable.

Common opioid drugs include:

• Fentanyl (Fentora, Subsys, Actiq, Lazanda, Abstral, Duragesic)

• Hydrocodone (Norco, Vicodin, Hysingla ER, Zohydro ER, Lortab)

• Hydromorphone (Dilaudid, Exalgo)

• Tapentadol (Nucynta)

• Buprenorphine (Suboxone, BuTrans/Belbuca)

• Codeine

• Morphine (Kadian, Embeda, Roxanol, MorphaBond, MS Contin)

• Tramadol (ConZip, Ultram ER Synapryn, Ryzolt, Ultram, Rybix ODT)

• Meperidine (Demerol, Meperitab)

• Oxycodone (Roxicodone, OxyContin, Percocet, Percodan, Xtampza ER)

If your lower back pain is chronic, other therapies like exercise or lifestyle changes may be more effective than opioids, especially given the potential side effects.

Possible side effects

Opioids have several potential side effects, and some are very serious, so you should always follow your doctor’s advice carefully.

Although opioids have a role in treating lower back pain, there is a risk of dependence and addiction. Opioids trigger the release of dopamine (a type of neurotransmitter) in a part of your brain called the limbic reward system. This can lead to physical dependence and addiction when the brain seeks to recreate the reward.

Research⁹ suggests that long-term use of opioids may also affect the endocrine system and lead to hormone changes, including reducing sex hormones like testosterone.

In the short term, opioids can cause constipation, nausea, dizziness, and drowsiness¹⁰.

Corticosteroids

Corticosteroids are a type of anti-inflammatory medication sometimes used to treat lower back pain. They contain an artificial version of cortisol, the inflammation-fighting hormone naturally produced in your body.

Your doctor might prescribe corticosteroids for oral use, or you might be given injections. Either way, they are usually only prescribed for short-term use.

Examples of corticosteroids include:

• Methylprednisolone (Medrol)

• Prednisone (Deltasone)

• Dexamethasone (Decadron)

Possible side effects

Corticosteroids can cause a range of side effects depending on the dosage and length of treatment. Side effects include weight gain, water retention, gastric ulcers, cataracts, blurred vision, bruising easily, and muscle weakness. They may also lead to serious health conditions like osteoporosis, high blood pressure, and diabetes.

When to see a doctor for your lower back pain

If your lower back pain is caused by an injury such as a fall, you should get checked out by a medical professional straight away. You should also seek urgent medical attention if you notice any of the following red flags:

• Constant or severe pain, particularly when you lie down

• Pain that spreads down your legs (especially if it extends below the knee)

• Numbness, tingling, or weakness in your legs

• Redness or swelling in the area

• Unexplained weight loss

• Severe abdominal or chest pain

• Difficulty breathing

• Loss of bladder or bowel control

If you don't know the reason for your pain and it persists for more than 1–2 weeks, you should see a doctor. Your doctor can identify what’s causing your lower back pain and work out a suitable treatment plan that may involve one or a combination of the medications mentioned above.

The lowdown

Lower back pain can cause a lot of discomfort and difficulty completing everyday tasks, but medications can effectively help ease pain and make daily life more manageable. Several medications are available for treating lower back pain, from paracetamol to steroids, but they all work differently.

Your doctor will prescribe the best medication to treat your lower back pain, although you can obtain some over the counter. Whichever medication you take, follow your doctor’s advice and any usage instructions carefully, since all medications carry the risk of side effects.