Back and neck pain can be miserable! Injury, herniated disc, spinal stenosis, osteoarthritis, vertebral compression fracture…, even a simple back sprain can cause life-altering pain. Back pain is one of the foremost reasons people seek medical care. Fortunately few cases of back pain require immediate spine surgery and can be treated with medication and physical therapy.
Yesterday vs. Today
Years ago patients with back pain were told to get off their feet and stay in bed for a week. After much scientific study, it has been proven that inactivity does little to help conquer back pain. Today doctors want to help their patients return to activity as quickly as possible.
The first step may include certain medications to control pain. When pain is controlled the patient may be able to participate in a physical therapy (PT) program. PT gives patients the tools needed to become strong and flexible, while learning proper biomechanics and injury prevention skills.
Medications – Overview
The various types of medications can be placed into 5 main groups, with each having a different purpose.
|1. Narcotics (opioids)||Short-term acute pain control|
|2. Muscle relaxants||Relieve muscle spasms and cramping|
|3. Non-steroidal anti-inflammatory||Reduce inflammation to alleviate pain (NSAIDs)|
|4. Sedatives||Promote rest and sleep to aid recovery|
|5. Analgesics||Long-term pain control|
Narcotics are used for a short period of time to control acute pain. When narcotics are taken long-term the body builds up a tolerance to the medicine requiring larger doses to control the same level of pain. All narcotics are derived from the juice of the opium poppy. The opium poppy contains several narcotic compounds including morphine and codeine.
Table 1: Opioid Analgesics: Class II
Table 2: Opioid Analgesics: Class III & IV
|Vicodin ES®||Hydrocodone bitartrate, acetaminophen|
|Tylenol® with Codeine||Acetaminophen, codeine|
|Fioricet® with Codeine||Butalbital, acetaminophen, codeine|
|Fiorina®l with Codeine||Butalbital, acetaminophen, codeine|
|Soma® with Codeine||Carisoprodol|
|Talwin NX ®||Pentazocine, naloxone|
Table 3: Neuropathic Pain Control
Medication to Relax Muscles
Muscle relaxants help to relieve spasms, cramping, and tightness that can cause pain. This type of medication acts on the central nervous system to produce a relaxant effect on muscles. Sometimes a pain reliever and a muscle relaxant are prescribed.
Table 4: Muscle Relaxants
|Soma® Compound||Carisoprodol, aspirin|
|Soma® Compound with Codeine||Carisoprodol, aspirin, codeine|
|Norgesic®||Orphenadrine, aspirin, caffeine|
Non-Steroidal Anti-Inflammatory Medications
There are hundreds of injury and spinal disorder scenarios that cause soft tissue inflammation. The nerve roots become irritated and inflamed from spinal stenosis or a herniated disc. Muscles become inflamed due to overuse or whiplash type injuries. Irritated, inflamed and swollen tissues cause pain.Non-steroidal anti-inflammatory drugs (NSAIDs) help to reduce inflammation to control pain.
Table 5: Non-Steroidal Anti-Inflammatory Drugs
|Trilisate||Choline magnesium trisalicylate|
Back Pain and Insomnia
Getting to sleep and staying asleep can be difficult when pain becomes your temporary partner. Your doctor understands this and may prescribe one of the following drugs to help you get a good night’s sleep. These drugs should not be taken long-term, as they can be habit-forming.
Table 6: Sedatives
Pain Relieving Patches and Creams
Many patients suffer chronic pain from a spinal disorder. For some conditions, a topical analgesic may be helpful. These must be used with care, as your doctor will explain.
Table 7: Topical Analgesics
|EMLA Cream®||Lidocaine, prilocaine|
Medication Side Effects
Taking prescription or over-the-counter (OTC) medications has risks in the form of side effects, drug interaction and liver damage. For those reasons it is important to tell your doctor everything about your past medical history, including allergies, medications (including OTCs) taken daily, and supplements (vitamins, herbs).
Before you take a prescription or OTC medication become aware of the side effects listed either with the Rx or on the bottle.
Table 8: Tell Your Doctor if You Suffer These Side Effects
|Dry mouth||Blurred Vision|
Table 9: CALL Your Doctor if You Suffer These Side Effects
|Fast or slow heartbeat||Trouble breathing|
|Facial swelling||Hives, skin rash, itching|
|Severe confusion or tiredness||Yellowing of the skin or eye|
|Black tarry stools||Severe weakness|
|Cold, clammy skin||Trouble urinating|
We are totally committed to helping our patients with effective pain-management. We combine our medical expertise with very careful assessment of each patient’s situation, and a thorough patient education session to achieve the best results..