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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.

A multi-ethnic group of young adults are working out at the gym by taking a cycling spin class.

 

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 (Opioids)

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

Brand Name

Generic Name/Component(s)

MS Contin® Duramorph
Dilaudid® Hydromorphone
Levo-Dromoran® Levorphanol
Demerol® Meperidine
Dolophine® Methadone
OxyContin® Oxycodone
Numorphan® Oxymorphone

Table 2: Opioid Analgesics: Class III & IV

Brand Name

Generic Name/Component(s)
Lortab® Acetaminophen, hydrocodone
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
Synalgos-DC® Dihyrocodeine bitartrate
Darvon® Propoxyphene
Darvocet® Propoxyphene
Wygesic® Propoxyphene, acetaminophen
Talacen® Pentazocine, acetaminophen
Talwin NX ® Pentazocine, naloxone

Table 3: Neuropathic Pain Control

Brand Name

Generic Name/Component(s)

Neuronton® Gabapentin

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

Brand Name

Generic Name/Component(s)

Soma® Carisoprodol
Soma® Compound Carisoprodol, aspirin
Soma® Compound with Codeine Carisoprodol, aspirin, codeine
Flexeril® Cycobenzaprine
Parafon forte® Chlorzoxazone
Skelaxin® Metaxolone
Robaxin® Methocarbamol
Robaxisal® Methocarbamol, aspirin
Norflex® Orphenadrine
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

Brand Name

Generic Name/Component(s)

Vioxx® Rofecoxib
Celebrex® Celecoxib
Bextra® Valdecoxib
Aspirin Salicylate
Trilisate Choline magnesium trisalicylate
Disalacid® Salsalate
Dolobid® Difunisal
Nalfon® Fenoprofen calcium
Motrin® Ibuprofen
Orudis® Ketoprofen
Naprosyn® Naproxen
Anaprox® Naproxen sodium
Indocin® Indomethacin
Clinoril® Suldinac
Lodine® Etodalac
Tolectin® Tolmetin
Feldene® Piroxicam
Cataflam® Dicofenac
Toradol® Ketorolac

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

Brand Name

Generic Name/Component(s)

Valium® Diazepam
Valrelease® Diazepam
Xanax® Alprazolam
Ambien® Zolpidem tartrate
Restoril® Tamazepam
Dalmane® Flurazepam
Sonata® Zaleplon

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

Brand Name

Generic Name/Component(s)

Lidoderm patch® Lidocaine
Duragesic patch® Fentanyl
EMLA Cream® Lidocaine, prilocaine
Capsaicin Cream Capsaicin
Zonalon™ Doxepin HCI

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

Dizziness Headache
Drowsiness Constipation
Dry mouth Blurred Vision
Nausea Vomiting

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
Hallucinate Behavioral changes

Conclusion

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..

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