What medications are used to manage back problems?

Analgesics (or painkillers) are commonly used to manage back pain. Analgesics include paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics.

Recent clinical practice guidelines from Australia and various other countries for management of low back pain have discouraged using pharmacotherapy as a first choice, and suggest medications only to those who have not adequately responded to non-pharmacological interventions (such as physical therapy). Guidelines encourage GPs to discuss with patients the risks and realistic benefits of medications before prescribing. If medications are used, they should be used at the lowest effective does and for the shortest amount of time possible [1].

The most common medications prescribed for back problems managed by GPs include opioids, paracetamol/opioid analgesic combination and NSAIDs. Paracetamol alone may not be effective in managing acute lower back pain, and is no longer recommended in treatment [2–5]. NSAIDS are recommended for both acute and chronic back pain management [2, 4, 5]. Opioids are commonly prescribed for lower back pain [6], however all guidelines suggest caution in using these medicines due to the increasing concern for potential harm [7]. Guidelines state opioids should only be used if expected benefits outweigh the risks for patients, and should not be used long term [1].

Treatment and management

Compared with people without chronic low back pain, people with chronic low back pain make greater use of pain-related medications and health care resources [8].

Pain is the main symptom of most back problems and treatment can be complex. This can be complicated by the existence of other comorbidities. As pain treatment is given at the same time as other treatments, serious drug interactions can be an issue [9].

Some general treatment strategies for chronic diseases can benefit people with back problems. For example, lifestyle modifications such as diet, exercise, weight control, and reducing smoking have been shown to be beneficial [10].

Reference

  1. Almeida M, Saragiotto B, Richards B & Maher CG 2018. Primary care management of non-specific low back pain: key messages from recent clinical guidelines. The Medical Journal of Australia 2018(6):272–275.
  2. National Institute for Health and Care Excellence 2016. Low back pain and sciatica in over 16s: assessment and management. NICE guideline. London: NICE.
  3. Stochkendahl MJ, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Anderson MO et al. 2018. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. European Spine Journal 27: 60–75.
  4. Van Wambeke P, Desomer A, Ailliet L, Berquin A, Demoulin C, Depreitere B et al. 2017. Summary: Low back pain and radicular pain: assessment and management. KCE report 287Cs. Brussels: Belgian Health Care Knowledge Centre (KCE), 2017.
  5. Qaseem A, Wilt TJ, McLean RM & Forciea MA 2017. Non-invasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine 166: 514-530.
  6. Kea B, Fu R, Lowe RA & Sun BC 2016. Interpreting the National Hospital Ambulatory Medical Care Survey: United States emergency department opioid prescribing, 2006–2010. Academic Emergency Medicine 23:159-165.
  7. Deyo RA, Von Korff M & Duhrkoop D 2015. Opioids for low back pain. BMJ 350:g6380.
  8. Gore M, Sadosky A, Stacey BR, Tai KS & Leslie D 2012. The burden of chronic low back pain: clinical comorbidities, treatment patterns, and health care costs in usual care settings. Spine (Phila Pa 1976) 37(11):E668–E677.
  9. Kozma CM, Provenzano DA, Slaton TL, Patal AA & Benson CJ 2014. Complexity of pain management among patients with nociceptive or neuropathic neck, back, or osteoarthritis diagnoses. Journal of Managed Care and Speciality Pharmacy 20(5):455–466b.
  10. Bauer UE, Briss PA, Goodman RA & Bowman BA 2014. Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet 384:45–52.