Arthritis Today

Medications to Treat Back Pain

Relieving back pain with medications.


Treatment for back problems depends on a number of factors including the findings of diagnostic tests. In many cases, medications to relieve pain and inflammation, slow bone loss or even slow or halt the progress of inflammatory disease are an important part of a back treatment plan.  Depending on your diagnosis, medical treatment may include one or more of the following medications.

Nonsteroidal anti-inflammatory drugs (NSAIDs). Including more than a dozen different drugs, some of which are available without a prescription, nonsteroidal anti-inflammatory drugs (NSAIDs) are used to help ease arthritis pain and inflammation. They may also be useful for relieving back pain from muscle strain and other causes. By far, most are taken orally. Recently, however, new topical preparations, such as Voltaren Gel and Pennsaid, have been approved.

Analgesics. Analgesics are among the most commonly used drugs for many forms of arthritis and other causes of back pain. Unlike NSAIDs, which target both, pain and inflammation, analgesics are designed purely for pain relief. For that reason, they may be safe for people who are unable to take NSAIDs due to allergies or stomach problems, for example. When taken as directed, analgesics also are an appropriate, and possibly safer, choice for pain not accompanied by inflammation.

Topical Rubs. If back pain is in the soft tissues, you may find relief from an analgesic salve, rub or balm available over the counter under trade names such as Aspercreme, Ben-Gay, Capzasin-P, Eucalyptamint, Icy Hot and Zostrix. Although these topical preparations, which work through a variety of active ingredients, are usually used on peripheral joints, such as the knees or hands, you might find them useful – and safe – for back pain.

Muscle Relaxants. These are drugs used to ease muscle spasms. For back pain relief, they are often prescribed along with NSAIDs. Commonly prescribed muscle relaxants include cyclobenzaprine (Flexeril), orphenadrine (Norflex) and carisoprodol (Soma). Muscle relaxants may cause drowsiness, so they may be helpful if back pain keeps you awake at night.

Corticosteroids. These quick-acting drugs, similar to the cortisone made by your own body, are used to control inflammation. If inflammation is due to a systemic inflammatory disease, such as polymyalgia rheumatica or rheumatoid arthritis in the back, your doctor may prescribe oral corticosteroids. If inflammation is limited to an inflamed joint in the spine, your doctor may inject a corticosteroid preparation directly into the inflamed joint.

Disease modifying anti-rheumatic drugs.  Disease-modifying anti-rheumatic drugs (DMARDs) work slowly to modify the course of inflammatory disease. Different DMARDs may be useful for a number of different forms of arthritis that may affect the spine, including rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.

Biologic response modifiers. The newest category of medications used for rheumatoid arthritis and a few other inflammatory forms of arthritis are the biologic agents. There are currently eight such agents approved by the Food and Drug Administration (FDA). Each blocks a step in the inflammation process without suppressing the entire immune system. In addition to rheumatoid arthritis, certain biologic agents may be used in juvenile arthritis, ankylosing spondylitis and psoriatic arthritis.

Gout medications. Some medications for gout are designed to reduce levels of uric acid in the blood to prevent future attacks of joint pain and inflammation. Others are designed to relieve the pain and inflammation of an acute attack. Many people with gout take both types of medication.

Osteoporosis medications. Osteoporosis medications are those used to slow the loss of bone or help the body build new bone. Although they are not used specifically to treat back problems, strong bones are less prone to fracture. Certain medications – called bisphophonates – in this category are also used to treat Paget's disease of the bone, which can also affect the spine.

Fibromyalgia medications.  Doctors prescribe medications from a variety of drug classes to treat fibromyalgia. Only three of these drugs – the anti-seizure medication pregabalin (Lyrica) and two antidepressants, duloxetine (Cymbalta) and milnacipran (Savella) – are FDA-approved to treat fibromyalgia. Many others are used off-label in fibromyalgia treatment because they have been shown in clinical trials to ease different symptoms. These include some other antidepressants, muscle relaxants and analgesics.