Painkillers
Medication for back pain
It is recommended that you take this medication regularly and not only when you are in a lot of pain. It can take a few days to start feeling the effect of some tablets (anti-inflammatories).
Try to be as active as you can and move regularly because if you don’t, your muscles and joints can become stiff and therefore more painful. Activity is very good and you will not cause any damage by moving. In fact it is the best thing you can do. With the typical backache, people can experience quite severe pain even though this does not tell us about the severity of injury or damage. Unfortunately we cannot rely on pain alone to understand what is going on.
If your condition is not improving after a week of regularly taking medication, then do visit your GP who is able to prescribe stronger medication. If you are improving then continue to take medication until you can move normally.
Remember that using ice or heat can be helpful.
Anti-inflammatories
Medication for radiating leg pain
Patient information
Medication
It may be necessary that you take medication to manage acute pain. Even though people worry taking painkillers masks the pain and causes more damage, it will be much worse for you if you stop moving and stiffen up.
Muscle relaxants
Useful information
Painkillers are used to reduce pain and they work by interfering with the pain signals from your brain. Do not wait till the pain gets severe in order to take painkillers. Many people feel they aren’t effective because they are not taking them correctly. Painkillers can be taken before exercise, during flare-ups or to ease the pain until it improves. Painkillers do not act against inflammation therefore they are often used alongside anti-inflammatories. There are many types of painkillers, often classified according to their strength.
1) Paracetamol (Panadol): These are suitable for mild to moderate pain and usually taken as a 500mg dose up to 4 times a day and causes very few side effects. Occasionally it can damage your liver if more than 4 000mg are taken per day and be careful if you have liver or kidney problems. Paracetamol is tolerated during pregnancy and breastfeeding if not taken regularly or more than 2 000mg per day. Cold and flu medication may contain paracetamol so be aware of this.
2) Co-codamol, co-dydramol: These are stronger painkillers used for moderate to severe pain. They are called compound analgesics because they contain a combination of different
drugs. This is usually a mix of paracetamol, aspirin, codeine and dihydrocodeine. Milder forms can be bought over the counter but most need a prescription. The side effects can cause nausea, constipation and loss of concentration.
3) Tramadol, Codeine, Morphine: These are the strongest types of painkillers for severe pain called opioid analgesics. They are only available as a prescription. They have more serious side effect than other painkillers and can be addictive. The side effects include nausea,constipation, vomiting, dizziness, drowsiness, reduced concentration, confusion and reduced ability to breath. Usually they are used if other painkillers have not worked or as a short-term pain relief.
There are various types of medication that you can take for back or leg pain. These are mainly divided into several categories: painkillers, anti-inflammatories, muscle relaxants and neuropathic medication.
Pain coming from nerves (such as in sciatica) can be a result of some damage to the nerves or nerve endings, which send pan signals to the spinal cord spontaneously or as a consequence of some stimulus that wouldn’t normally cause pain. Nerve pain can be severe and debilitating therefore specific medications are used in combination with painkillers. Nerve pain medications include amitriptyline, gabapentin, pregabalin.
• Amitriptyline: This is an antidepressant drug, which has painkilling and sedative effects. It is used in low doses (5-75mg) before going to bed to treat nerve pain. The side effects cause drowsiness, dry mouth, constipation, blurred vision, difficulty passing urine (mainly in men with prostate problems), dizziness (more in the elderly) or irregular heart beat (take care if you have heart problems). You may feel drowsy in the morning, especially if you take Amitriptyline too late at night so try taking it no later than 8pm with a low dose.
• Gabapentin and Pregabalin: These are also used to treat nerve pain in the most troublesome cases
These non-steroidal anti-inflammatory drugs help reduce inflammation around the painful area. NSAIDs start working in a few hours and some effects can last a shorter duration than others. There are more than 20 different NSAIDs and the most common ones are Aspirin and Ibuprofen. Some NSAIDs are over-the-counter medications (Aspirin, Ibuprofen 200mg, Naproxen) but for others a prescription from a doctor is required.
• Ibuprofen, Naproxen: Is commonly used as a painkiller and anti-inflammatory. It is available over the counter in 200-400mg doses and is taken up to four times a day with
food. It has reduced side effects (nausea, vomiting, diarrhea, indigestion) compared with Aspirin and is therefore more often prescribed. Ibuprofen creams and gels are also
available and these are rubbed directly onto the painful area.
• Aspirin: Is used as a painkiller for mild to moderate pain as well as for inflammation and to reduce fever. It is available over the counter in 300mg tablets and normally used up to four times a day after food as a single or double-dose. Aspirin causes side effects such as stomach-related problems, bleeding in the digestive system (especially with high alcohol consumption, taking warfarin or age over 60 years). Do not use fish oil when you are taking Aspirin as they can interact and avoid this drug if you have heartburn, indigestion or a history of stomach ulcers. Aspirin can worsen asthma or cause rashes and hives. If you get any of these side effects, stop taking this drug. In low doses (75mg) Aspirin is used to reduce the risk of strokes and heart attacks but this does not provide pain relief and others NSAIDs must be taken with caution.
• Diclofenac, Voltarol: These are some of the other types of NSAIDs with similar effects.
Instructions: Use NSAIDs in the correct dosage with food
dose, take it as soon as possible with food and water. But do
Side effects include stomach upset, mild nauseas, diarrhoea, it can interfere with high blood pressure, kidney problems, asthma and others.
Muscle relaxants are used to treat muscle spasms, which are often associated with back pain. The spasms can be painful as the muscles are continuously being activated to guard the spine but they can also make movement stiff and painful. Prolonged spasms are not helpful even though they may be effective as a healing response for acute pain. Muscle relaxants have an overall sedative effect on the body so they do not directly act on the muscles but more as a whole body
relaxant.
• Diazepam: This drug is used to treat muscle spasms but also anxiety disorders or alcohol withdrawal symptoms. Diazepam works by affecting chemicals in the brain that may become unbalanced. Do not take this drug if you are pregnant, allergic, if you have severe liver disease, myasthenia gravis, breathing problems or sleep apnea. Do not drink alcohol when taking diazepam as this can increase the effects of alcohol. Side effects include drowsiness,
dizziness, feeling irritable, muscle weakness, nausea, blurred vision, mild skin rash and dry mouth. The normal dose is 2-10mg taken up to 4 times a day.
• Baclofen, Dantrolen, Tizanidine are other types of muscle relaxants
• Dantrolene acts directly on the muscles
